Provider Demographics
NPI:1376692699
Name:LEONE, PHILIP A (DDS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:LEONE
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 1:5669 MAHONING AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2339
Mailing Address - Country:US
Mailing Address - Phone:330-792-2749
Mailing Address - Fax:330-792-1128
Practice Address - Street 1:5669 MAHONING AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2339
Practice Address - Country:US
Practice Address - Phone:330-792-2749
Practice Address - Fax:330-792-1128
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH159821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice