Provider Demographics
NPI:1245259126
Name:POLIZIANI, LEONARD L JR (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:L
Last Name:POLIZIANI
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632-1326
Mailing Address - Country:US
Mailing Address - Phone:724-327-1390
Mailing Address - Fax:724-327-2788
Practice Address - Street 1:5834 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632-1326
Practice Address - Country:US
Practice Address - Phone:724-327-1390
Practice Address - Fax:724-327-2788
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026777-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice