Provider Demographics
NPI:1255469789
Name:LEONARD, GARY CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHARLES
Last Name:LEONARD
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 1:401 S MAIN ST
Mailing Address - Street 2:STE B-4
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1974
Mailing Address - Country:US
Mailing Address - Phone:770-475-7207
Mailing Address - Fax:770-475-0484
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:STE B-4
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1974
Practice Address - Country:US
Practice Address - Phone:770-475-7207
Practice Address - Fax:770-475-0484
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice