Provider Demographics
NPI:1063661981
Name:BADGER, LEONARD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:M
Last Name:BADGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 DR PHILLIPS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5123
Mailing Address - Country:US
Mailing Address - Phone:407-370-0200
Mailing Address - Fax:407-370-0277
Practice Address - Street 1:7009 DR PHILLIPS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5123
Practice Address - Country:US
Practice Address - Phone:407-370-0200
Practice Address - Fax:407-370-0277
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist