Provider Demographics
NPI:1083124515
Name:HOWARD, LEON ,JR. (DDS)
Entity Type:Individual
Prefix:
First Name:LEON ,JR.
Middle Name:
Last Name:HOWARD
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 1:214 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-7641
Mailing Address - Country:US
Mailing Address - Phone:478-471-2929
Mailing Address - Fax:478-757-3651
Practice Address - Street 1:4600 FULTON MILL RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31208-2500
Practice Address - Country:US
Practice Address - Phone:478-471-2929
Practice Address - Fax:478-757-3651
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33861223G0001X
GA0087721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty