Provider Demographics
NPI:1518974146
Name:CUSCIANNA, LEONARD G (DDS)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:G
Last Name:CUSCIANNA
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 1:420 WASHINGTON ST
Mailing Address - Street 2:101
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4755
Mailing Address - Country:US
Mailing Address - Phone:781-848-2422
Mailing Address - Fax:
Practice Address - Street 1:420 WASHINGTON ST
Practice Address - Street 2:101
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4755
Practice Address - Country:US
Practice Address - Phone:781-848-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice