Provider Demographics
NPI:1740364777
Name:LEIZER, JAMIE L (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:L
Last Name:LEIZER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LLOYD CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5692
Mailing Address - Country:US
Mailing Address - Phone:732-254-6019
Mailing Address - Fax:
Practice Address - Street 1:125 LINCOLN AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-2738
Practice Address - Country:US
Practice Address - Phone:732-541-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02229400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist