Provider Demographics
NPI:1003817727
Name:LEONARD, THOMAS MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:LEONARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MASS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6733
Mailing Address - Country:US
Mailing Address - Phone:781-646-8609
Mailing Address - Fax:
Practice Address - Street 1:366 MASS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6733
Practice Address - Country:US
Practice Address - Phone:781-646-8609
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice