Provider Demographics
NPI:1508434374
Name:BREITMAN, LEELA SIVIE (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:LEELA
Middle Name:SIVIE
Last Name:BREITMAN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021B CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2733
Mailing Address - Country:US
Mailing Address - Phone:215-728-1696
Mailing Address - Fax:
Practice Address - Street 1:8021B CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2733
Practice Address - Country:US
Practice Address - Phone:215-728-1696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123191223G0001X
PADS0434111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral Practice