Provider Demographics
NPI:1922002880
Name:ABBOTT, LEO T (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:T
Last Name:ABBOTT
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-0068
Mailing Address - Country:US
Mailing Address - Phone:603-542-7100
Mailing Address - Fax:
Practice Address - Street 1:27 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2546
Practice Address - Country:US
Practice Address - Phone:603-542-7100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11412OtherMASSACHUSETTS LICENSE
NH1131OtherNH DENTIST LICENSE