Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN 5223 | FL |
NPI | 1104246123 |
---|---|
Provider Name | Dr. Ronald Elliot Leventhal |
First Address | Miami, FL 33173-3570 |
Second Address | Miami, FL 33173-3570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 17/04/2014 |