Provider Demographics
NPI:1841737608
Name:PLANZOS, LEA
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:PLANZOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3701
Mailing Address - Country:US
Mailing Address - Phone:718-748-1507
Mailing Address - Fax:718-748-1507
Practice Address - Street 1:7815 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3701
Practice Address - Country:US
Practice Address - Phone:718-748-1507
Practice Address - Fax:718-748-1507
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058704-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics