Provider Demographics
NPI:1629264304
Name:LEONARD ORTHDONTICS, LLC
Entity Type:Organization
Organization Name:LEONARD ORTHDONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANGELIC
Authorized Official - Last Name:GANGOY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-687-3500
Mailing Address - Street 1:797 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6120
Mailing Address - Country:US
Mailing Address - Phone:978-687-3500
Mailing Address - Fax:
Practice Address - Street 1:797 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-6120
Practice Address - Country:US
Practice Address - Phone:978-687-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEONARD ORTHODONTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-17
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty