Provider Demographics
NPI:1922095942
Name:TOM, LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:TOM
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 1:385 CONCORD AVE
Mailing Address - Street 2:SUITE 001
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3083
Mailing Address - Country:US
Mailing Address - Phone:617-484-1920
Mailing Address - Fax:617-484-1862
Practice Address - Street 1:385 CONCORD AVE
Practice Address - Street 2:SUITE 001
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3083
Practice Address - Country:US
Practice Address - Phone:617-484-1920
Practice Address - Fax:617-484-1862
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice