Provider Demographics
NPI:1124180492
Name:TADDEI, LEONARD CARL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:CARL
Last Name:TADDEI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 AQUIDNECK AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7246
Mailing Address - Country:US
Mailing Address - Phone:401-847-2094
Mailing Address - Fax:401-847-2094
Practice Address - Street 1:770 AQUIDNECK AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7246
Practice Address - Country:US
Practice Address - Phone:401-847-2094
Practice Address - Fax:401-847-2094
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI19401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice