Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 004540 | CT |
NPI | 1093085144 |
---|---|
Provider Name | Dr. Joel M Leon |
First Address | Greenwich, CT 06830-6626 |
Second Address | Greenwich, CT 06830-6626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 06/01/2012 |