Provider Demographics
NPI:1922147537
Name:LEONG, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:LEONG
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 1:115 W STEWART AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3607
Mailing Address - Country:US
Mailing Address - Phone:541-773-3703
Mailing Address - Fax:
Practice Address - Street 1:115 W STEWART AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3607
Practice Address - Country:US
Practice Address - Phone:541-773-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist