Provider Demographics
NPI:1598986226
Name:YUDKIN, LEO (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:YUDKIN
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 POCONO RD STE 211
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2907
Mailing Address - Country:US
Mailing Address - Phone:973-664-0181
Mailing Address - Fax:973-664-0182
Practice Address - Street 1:16 POCONO RD STE 211
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2907
Practice Address - Country:US
Practice Address - Phone:973-664-0181
Practice Address - Fax:973-664-0182
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0198811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics