Provider Demographics
NPI:1093085144
Name:LEON, JOEL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:M
Last Name:LEON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:138 MILBANK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6626
Mailing Address - Country:US
Mailing Address - Phone:203-869-8345
Mailing Address - Fax:203-869-0909
Practice Address - Street 1:138 MILBANK AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6626
Practice Address - Country:US
Practice Address - Phone:203-869-8345
Practice Address - Fax:203-869-0909
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0045401223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics