Provider Demographics
NPI:1851502272
Name:LEO, ROSANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:
Last Name:LEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-3920
Mailing Address - Country:US
Mailing Address - Phone:914-906-2879
Mailing Address - Fax:914-337-8273
Practice Address - Street 1:88 LAKE AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-3920
Practice Address - Country:US
Practice Address - Phone:914-906-2879
Practice Address - Fax:914-337-8273
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052279332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies