Provider Demographics
NPI:1396181871
Name:DISCAVAGE, LEON R
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:R
Last Name:DISCAVAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LEON
Other - Middle Name:
Other - Last Name:DISCAVAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:13975 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2921
Mailing Address - Country:US
Mailing Address - Phone:301-871-6660
Mailing Address - Fax:301-871-7300
Practice Address - Street 1:13975 CONNECTICUT AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-871-6660
Practice Address - Fax:301-871-7300
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist