Provider Demographics
NPI:1043971179
Name:SARAIVA, LEONARDO NOGUEIRA
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:NOGUEIRA
Last Name:SARAIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 SOAPSTONE PL # 101
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3256
Mailing Address - Country:US
Mailing Address - Phone:585-350-4370
Mailing Address - Fax:
Practice Address - Street 1:5482 SOAPSTONE PL # 101
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3256
Practice Address - Country:US
Practice Address - Phone:585-350-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist