Provider Demographics
NPI:1023092087
Name:LEDAKIS, JOHN S (DDS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:LEDAKIS
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 1:4512 N FLAGLER DRIVE
Mailing Address - Street 2:STE 301
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-863-9884
Mailing Address - Fax:561-848-7040
Practice Address - Street 1:4512 N FLAGLER DRIVE
Practice Address - Street 2:STE 301
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407
Practice Address - Country:US
Practice Address - Phone:561-863-9884
Practice Address - Fax:561-848-7040
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist