Provider Demographics
NPI:1609073832
Name:LEITMAN, DANIEL CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CHARLES
Last Name:LEITMAN
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 1:185 LIBERTY ST APT A5
Mailing Address - Street 2:APT 5A
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1770
Mailing Address - Country:US
Mailing Address - Phone:973-953-2336
Mailing Address - Fax:
Practice Address - Street 1:203 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:973-744-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0218151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice