Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 8614 | MD |
NPI | 1073547337 |
---|---|
Provider Name | Dr. Richard Leupold |
First Address | Washington, DC 20422-0001 |
Second Address | Washington, DC 20422-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |