Provider Demographics
NPI:1508903923
Name:LEONI, SUSAN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:LEONI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SKIPPACK PIKE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422
Mailing Address - Country:US
Mailing Address - Phone:215-641-2800
Mailing Address - Fax:215-641-2801
Practice Address - Street 1:1380 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1255
Practice Address - Country:US
Practice Address - Phone:610-279-2024
Practice Address - Fax:215-279-5886
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02475 L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice