Provider Demographics
NPI:1558146191
Name:PETRELLA, LEANDRO (DDS)
Entity Type:Individual
Prefix:
First Name:LEANDRO
Middle Name:
Last Name:PETRELLA
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 1:4106 E PARHAM RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2734
Mailing Address - Country:US
Mailing Address - Phone:804-672-3030
Mailing Address - Fax:
Practice Address - Street 1:4106 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2734
Practice Address - Country:US
Practice Address - Phone:804-672-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014185971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics