Provider Demographics
NPI:1205138088
Name:SHARI T. LEAVITT, DMD, PC
Entity type:Organization
Organization Name:SHARI T. LEAVITT, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:TARA
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-662-1030
Mailing Address - Street 1:3901 MARKET ST
Mailing Address - Street 2:BOX 1936
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3133
Mailing Address - Country:US
Mailing Address - Phone:215-662-1030
Mailing Address - Fax:215-662-1015
Practice Address - Street 1:3901 MARKET ST
Practice Address - Street 2:BOX 1936
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3133
Practice Address - Country:US
Practice Address - Phone:215-662-1030
Practice Address - Fax:215-662-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025799-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty