Provider Demographics
NPI:1922195833
Name:LEIZEROVICH, IGAL (DDS)
Entity type:Individual
Prefix:DR
First Name:IGAL
Middle Name:
Last Name:LEIZEROVICH
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 1:491 HELGA CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3866
Mailing Address - Country:US
Mailing Address - Phone:818-521-7780
Mailing Address - Fax:818-981-4564
Practice Address - Street 1:4350 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3031
Practice Address - Country:US
Practice Address - Phone:818-981-4508
Practice Address - Fax:818-981-4564
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice