Provider Demographics
NPI:1790485043
Name:DAVANZO, LEIGH ANNE
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANNE
Last Name:DAVANZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 NOTTINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4727
Mailing Address - Country:US
Mailing Address - Phone:561-213-7201
Mailing Address - Fax:
Practice Address - Street 1:12785 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4777
Practice Address - Country:US
Practice Address - Phone:561-213-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH19396124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist