Provider Demographics
NPI:1750495891
Name:ACKERMANN, LEONARD V (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:V
Last Name:ACKERMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2516
Mailing Address - Country:US
Mailing Address - Phone:763-427-2740
Mailing Address - Fax:763-427-1363
Practice Address - Street 1:402 MONROE ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2516
Practice Address - Country:US
Practice Address - Phone:763-427-2740
Practice Address - Fax:763-427-1363
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND72821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics