Provider Demographics
NPI:1821100256
Name:LEONI, RANDAL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:J
Last Name:LEONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 CHERRYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7360
Mailing Address - Country:US
Mailing Address - Phone:760-500-6197
Mailing Address - Fax:
Practice Address - Street 1:1955 CHERRYWOOD ST
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7360
Practice Address - Country:US
Practice Address - Phone:760-500-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice