Provider Demographics
NPI:1467861039
Name:LESCHINSKY, BERNICE ALLA (DMD)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:ALLA
Last Name:LESCHINSKY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MCINTOSH DR
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3271
Mailing Address - Country:US
Mailing Address - Phone:201-956-5675
Mailing Address - Fax:
Practice Address - Street 1:19-21 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2331
Practice Address - Country:US
Practice Address - Phone:201-475-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02184500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist