Provider Demographics
NPI:1639187529
Name:LEISS, JEFFREY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:B
Last Name:LEISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 JOHN ROBERT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-363-2900
Mailing Address - Fax:610-363-7722
Practice Address - Street 1:132 JOHN ROBERT THOMAS DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-2900
Practice Address - Fax:610-363-7722
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028064L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics