Provider Demographics
NPI:1164139614
Name:LEONETTI, JULIA (RDH)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:LEONETTI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:GOLDSMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2758 SOUTH STREAM RD
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-379-4166
Mailing Address - Fax:
Practice Address - Street 1:181 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-9001
Practice Address - Country:US
Practice Address - Phone:802-379-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT015.0001552124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist