Provider Demographics
NPI:1750651931
Name:LITKOWSKI, LEONARD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JOHN
Last Name:LITKOWSKI
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 1:5775 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21661
Mailing Address - Country:US
Mailing Address - Phone:410-778-1234
Mailing Address - Fax:
Practice Address - Street 1:5775 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK HALL
Practice Address - State:MD
Practice Address - Zip Code:21661
Practice Address - Country:US
Practice Address - Phone:410-778-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD91051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice