Provider Demographics
NPI:1518157767
Name:JAMES, LEON DEMONT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:DEMONT
Last Name:JAMES
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 1:30 DUTCHESS LANDING RD APT C302
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1684
Mailing Address - Country:US
Mailing Address - Phone:860-805-2401
Mailing Address - Fax:860-805-2401
Practice Address - Street 1:150 E HIGHWAY 67
Practice Address - Street 2:SUITE 180
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-4411
Practice Address - Country:US
Practice Address - Phone:972-709-4800
Practice Address - Fax:972-709-7700
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009754122300000X
TX246551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0042235992Medicaid
CTC00394Medicare PIN