Provider Demographics
NPI:1679662860
Name:LEONE, PETER (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:LEONE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30140 HARPER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082
Mailing Address - Country:US
Mailing Address - Phone:586-285-9888
Mailing Address - Fax:586-285-9898
Practice Address - Street 1:30140 HARPER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082
Practice Address - Country:US
Practice Address - Phone:586-285-9888
Practice Address - Fax:586-285-9898
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010158271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics