Provider Demographics
NPI:1336636984
Name:GOODE, LEO T (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:T
Last Name:GOODE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ELM SPRING RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1005
Mailing Address - Country:US
Mailing Address - Phone:412-344-9988
Mailing Address - Fax:412-344-0609
Practice Address - Street 1:833 ELM SPRING RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1005
Practice Address - Country:US
Practice Address - Phone:412-344-9988
Practice Address - Fax:412-344-0609
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019032L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty