Provider Demographics
NPI:1912564949
Name:NASSANI, LEONARDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:NASSANI
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 1:555 W 5TH AVE
Mailing Address - Street 2:APT 209
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-4537
Mailing Address - Country:US
Mailing Address - Phone:614-216-1616
Mailing Address - Fax:
Practice Address - Street 1:POSTLE HALL, 305 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-216-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2022-01-05
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2021-12-29
Provider Licenses
StateLicense IDTaxonomies
OH30.0264091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice