Provider Demographics
NPI:1225125024
Name:PICCOLI, LEANDRO S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEANDRO
Middle Name:S
Last Name:PICCOLI
Suffix:
Gender:M
Credentials:DDS
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Other - Credentials:
Mailing Address - Street 1:1011 CLIFTON AVE
Mailing Address - Street 2:P&C PEDIATRIC DENTISTRY
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3518
Mailing Address - Country:US
Mailing Address - Phone:973-928-3880
Mailing Address - Fax:973-928-3879
Practice Address - Street 1:1011 CLIFTON AVE
Practice Address - Street 2:P&C PEDIATRIC DENTISTRY
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3518
Practice Address - Country:US
Practice Address - Phone:973-928-3880
Practice Address - Fax:973-928-3879
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJDI0228171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry