Provider Demographics
NPI:1871036400
Name:LEFFALL FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:LEFFALL FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIA
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:LEFFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-941-5656
Mailing Address - Street 1:2814 S BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3526
Mailing Address - Country:US
Mailing Address - Phone:214-941-5656
Mailing Address - Fax:
Practice Address - Street 1:2814 S BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3526
Practice Address - Country:US
Practice Address - Phone:214-941-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92653802261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental