Provider Demographics
NPI:1013930411
Name:LEIFERT, MICHAEL FREDRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDRICK
Last Name:LEIFERT
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 1:30 5TH AVE
Mailing Address - Street 2:SUITE 1J.K.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8859
Mailing Address - Country:US
Mailing Address - Phone:212-533-7880
Mailing Address - Fax:212-533-0162
Practice Address - Street 1:30 5TH AVE
Practice Address - Street 2:SUITE 1J.K.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8859
Practice Address - Country:US
Practice Address - Phone:212-533-7880
Practice Address - Fax:212-533-0162
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0501681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics