Provider Demographics
NPI:1629147335
Name:DELEONIBUS, JOANN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:M
Last Name:DELEONIBUS
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 1:139 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4616
Mailing Address - Country:US
Mailing Address - Phone:718-625-6437
Mailing Address - Fax:718-624-5711
Practice Address - Street 1:139 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4616
Practice Address - Country:US
Practice Address - Phone:718-625-6437
Practice Address - Fax:718-624-5711
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040747-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice