Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 7142 | FL |
NPI | 1023301421 |
---|---|
Provider Name | Dr. Julian Charles Leichter |
First Address | Boca Raton, FL 33433 |
Second Address | Boca Raton, FL 33433-5532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 18/05/2011 |