Provider Demographics
NPI:1174798219
Name:GHAFFARI, LEELA B (DMD)
Entity type:Individual
Prefix:DR
First Name:LEELA
Middle Name:B
Last Name:GHAFFARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LEELA
Other - Middle Name:B
Other - Last Name:GHAFFARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:60 E END AVE APT 38A
Mailing Address - Street 2:38A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-7908
Mailing Address - Country:US
Mailing Address - Phone:212-734-3355
Mailing Address - Fax:
Practice Address - Street 1:60 E END AVE APT 38A
Practice Address - Street 2:38A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7908
Practice Address - Country:US
Practice Address - Phone:212-734-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0504791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice