Provider Demographics
NPI:1053392977
Name:LEIBOWITZ, BRIAN C (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:C
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3526
Mailing Address - Country:US
Mailing Address - Phone:631-467-4440
Mailing Address - Fax:631-467-0925
Practice Address - Street 1:2535 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3526
Practice Address - Country:US
Practice Address - Phone:631-467-4440
Practice Address - Fax:631-467-0925
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice