Provider Demographics
NPI:1548807555
Name:STEIN, LEEZA (DDS)
Entity type:Individual
Prefix:DR
First Name:LEEZA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E RALPH HALL PKWY STE 114
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6514
Mailing Address - Country:US
Mailing Address - Phone:972-771-2213
Mailing Address - Fax:
Practice Address - Street 1:1300 E RALPH HALL PKWY STE 114
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6514
Practice Address - Country:US
Practice Address - Phone:972-771-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice