Provider Demographics
NPI:1609931922
Name:DAVIDSON, LEONARD A (DDS FAGD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:A
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7172 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1530
Mailing Address - Country:US
Mailing Address - Phone:440-235-3060
Mailing Address - Fax:440-235-2382
Practice Address - Street 1:7172 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1530
Practice Address - Country:US
Practice Address - Phone:440-235-3060
Practice Address - Fax:440-235-2382
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice