Provider Demographics
NPI:1750507349
Name:LEONARD, JOHN DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DENNIS
Last Name:LEONARD
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 1:7404 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-1132
Mailing Address - Country:US
Mailing Address - Phone:814-474-3713
Mailing Address - Fax:814-474-9803
Practice Address - Street 1:7404 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1132
Practice Address - Country:US
Practice Address - Phone:814-474-3713
Practice Address - Fax:814-474-9803
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA026186L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist