Individual
LEONID ITSKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 STATE STR, TEANEAK, NJ 07666
(201) 837-3000
(201) 837-0992
Mailing address
146 GROVE STR, BERGENFIELD, NJ 07621
(718) 208-9646
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI02179000
NJ
Other
Enumeration date
10/26/2006
Last updated
07/08/2007
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