Provider Demographics
NPI:1679681928
Name:SPYROU, LEONIDAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONIDAS
Middle Name:
Last Name:SPYROU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:LEO
Other - Middle Name:
Other - Last Name:SPYROU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2 HAVEN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2958
Mailing Address - Country:US
Mailing Address - Phone:781-944-7970
Mailing Address - Fax:781-942-7259
Practice Address - Street 1:2 HAVEN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2958
Practice Address - Country:US
Practice Address - Phone:781-944-7970
Practice Address - Fax:781-942-7259
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA191411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0202967Medicaid