Provider Demographics
NPI:1962469130
Name:ANDRE, LEONARD P (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:P
Last Name:ANDRE
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 1:500 SAGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6133
Mailing Address - Country:US
Mailing Address - Phone:901-860-0719
Mailing Address - Fax:
Practice Address - Street 1:2136 EXETER RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3935
Practice Address - Country:US
Practice Address - Phone:901-756-8577
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS41561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice