Provider Demographics
NPI:1871618942
Name:CYRIL V LEDDY DDS PC
Entity type:Organization
Organization Name:CYRIL V LEDDY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:LEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-372-7218
Mailing Address - Street 1:312 LANCASTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611
Mailing Address - Country:US
Mailing Address - Phone:610-372-7218
Mailing Address - Fax:610-372-7595
Practice Address - Street 1:312 LANCASTER AVENUE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-372-7218
Practice Address - Fax:610-372-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020420L1223G0001X
PADS022255L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA415185Medicaid
PA61796Medicare ID - Type Unspecified
T30272Medicare UPIN