Provider Demographics
NPI:1568020618
Name:LEIBOWITZ, MARCUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 TUCKAHOE RD STE 380
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3845
Mailing Address - Country:US
Mailing Address - Phone:856-878-2330
Mailing Address - Fax:
Practice Address - Street 1:141 TUCKAHOE RD STE 380
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3845
Practice Address - Country:US
Practice Address - Phone:856-878-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ22DI02785400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program