Provider Demographics
NPI:1982814943
Name:BEARE, LEONARD EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:EUGENE
Last Name:BEARE
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 1:8251 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4602
Mailing Address - Country:US
Mailing Address - Phone:623-334-3300
Mailing Address - Fax:623-334-3399
Practice Address - Street 1:8251 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4602
Practice Address - Country:US
Practice Address - Phone:623-334-3300
Practice Address - Fax:623-334-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19791223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1979OtherDENTAL LICENSE