Provider Demographics
NPI:1073628186
Name:LIRA, LEANDRO MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEANDRO
Middle Name:MICHAEL
Last Name:LIRA
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 1:3505 VICKSBURG LN N
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1342
Mailing Address - Country:US
Mailing Address - Phone:763-694-7500
Mailing Address - Fax:
Practice Address - Street 1:3505 VICKSBURG LN N
Practice Address - Street 2:SUITE 1200
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1342
Practice Address - Country:US
Practice Address - Phone:763-694-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist