Provider Demographics
NPI:1851683759
Name:ARDILA VELOSA, LEONARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:ARDILA VELOSA
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 1:2801 SW 71ST TER APT 1012
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1121
Mailing Address - Country:US
Mailing Address - Phone:954-552-3879
Mailing Address - Fax:
Practice Address - Street 1:2801 SW 71ST TER
Practice Address - Street 2:APT 1012
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1121
Practice Address - Country:US
Practice Address - Phone:954-552-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20109122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist