Provider Demographics
NPI:1811237167
Name:BLITZ, LEAH LIDDLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:LIDDLE
Last Name:BLITZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3136 U.S. ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:NY
Mailing Address - Zip Code:13797
Mailing Address - Country:US
Mailing Address - Phone:607-341-1221
Mailing Address - Fax:
Practice Address - Street 1:3136 U.S. ROUTE 11
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:NY
Practice Address - Zip Code:13797
Practice Address - Country:US
Practice Address - Phone:607-692-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0567901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice