Provider Demographics
NPI:1174862221
Name:ROUTENBERG, LEONARD JORDAN (DDS)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:JORDAN
Last Name:ROUTENBERG
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 1:4511 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:A-2
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6243
Mailing Address - Country:US
Mailing Address - Phone:770-394-6778
Mailing Address - Fax:770-394-5060
Practice Address - Street 1:4511 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:A-2
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6243
Practice Address - Country:US
Practice Address - Phone:770-394-6778
Practice Address - Fax:770-394-5060
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist