Provider Demographics
NPI:1497882716
Name:LEBRON, EVA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:
Last Name:LEBRON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3507
Mailing Address - Country:US
Mailing Address - Phone:212-923-6280
Mailing Address - Fax:212-568-8190
Practice Address - Street 1:436 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3507
Practice Address - Country:US
Practice Address - Phone:212-923-6280
Practice Address - Fax:212-568-8190
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0465811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice