Provider Demographics
NPI:1508192006
Name:LEON A. WERTHEIMER, D.D.S.
Entity Type:Organization
Organization Name:LEON A. WERTHEIMER, D.D.S.
Other - Org Name:MAIN LINE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WERTHEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-668-0606
Mailing Address - Street 1:352 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1202
Mailing Address - Country:US
Mailing Address - Phone:610-668-0606
Mailing Address - Fax:610-668-8427
Practice Address - Street 1:352 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:MERION STATION
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019271-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty