Provider Demographics
NPI:1023083672
Name:WERTHEIMER, LEON A (DDS)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:A
Last Name:WERTHEIMER
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 1:118 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2919
Mailing Address - Country:US
Mailing Address - Phone:610-667-2039
Mailing Address - Fax:610-667-8089
Practice Address - Street 1:352 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:MERION
Practice Address - State:PA
Practice Address - Zip Code:19066-1202
Practice Address - Country:US
Practice Address - Phone:610-668-0606
Practice Address - Fax:610-668-8427
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 019271-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice