Provider Demographics
NPI:1326234311
Name:DR. LEONARD L. RADNOR DMD
Entity Type:Organization
Organization Name:DR. LEONARD L. RADNOR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RADNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-941-3570
Mailing Address - Street 1:157 WATERDAM RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2573
Mailing Address - Country:US
Mailing Address - Phone:724-941-3570
Mailing Address - Fax:724-941-2988
Practice Address - Street 1:157 WATERDAM RD
Practice Address - Street 2:SUITE 140
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2573
Practice Address - Country:US
Practice Address - Phone:724-942-3570
Practice Address - Fax:724-941-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027734L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA734382OtherUNITED CONCORDIA PROVIDER