Provider Demographics
NPI:1457509572
Name:RICHARD N. LEADERMAN, DDS, PC
Entity Type:Organization
Organization Name:RICHARD N. LEADERMAN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:LEADERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-736-6185
Mailing Address - Street 1:1284 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1827
Mailing Address - Country:US
Mailing Address - Phone:413-736-6185
Mailing Address - Fax:413-731-7116
Practice Address - Street 1:1284 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1847
Practice Address - Country:US
Practice Address - Phone:413-736-6185
Practice Address - Fax:413-731-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty