Provider Demographics
NPI:1447390885
Name:ANGLIS, LEONARD F (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:F
Last Name:ANGLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 SOUTH COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307
Mailing Address - Country:US
Mailing Address - Phone:219-226-9380
Mailing Address - Fax:219-226-9381
Practice Address - Street 1:1549 S COURT ST STE C
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4809
Practice Address - Country:US
Practice Address - Phone:219-226-9380
Practice Address - Fax:219-226-9381
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN78051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice