Provider Demographics
NPI:1265442578
Name:MENENDEZ, LEO F (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:F
Last Name:MENENDEZ
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 1:3233 SUPERIOR LN
Mailing Address - Street 2:SUITE B-23
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1920
Mailing Address - Country:US
Mailing Address - Phone:301-262-4500
Mailing Address - Fax:301-262-2912
Practice Address - Street 1:3233 SUPERIOR LN
Practice Address - Street 2:SUITE B-23
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1920
Practice Address - Country:US
Practice Address - Phone:301-262-4500
Practice Address - Fax:301-262-2912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102941223S0112X
DC57291223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery