Provider Demographics
NPI:1467678235
Name:LEGGIERI, LAWRENCE R SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:R
Last Name:LEGGIERI
Suffix:SR
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 1:929 LYCOMING MALL DR
Mailing Address - Street 2:
Mailing Address - City:PENNSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:17756-7837
Mailing Address - Country:US
Mailing Address - Phone:570-546-8888
Mailing Address - Fax:570-546-7053
Practice Address - Street 1:929 LYCOMING MALL DR
Practice Address - Street 2:
Practice Address - City:PENNSDALE
Practice Address - State:PA
Practice Address - Zip Code:17756-7837
Practice Address - Country:US
Practice Address - Phone:570-546-8888
Practice Address - Fax:570-546-7053
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027476-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA643550Medicare UPIN