Provider Demographics
NPI:1255314027
Name:ALLEN, LEONARD FRANKLIN (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:FRANKLIN
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 DOUBLE CHURCHES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2741
Mailing Address - Country:US
Mailing Address - Phone:706-596-1757
Mailing Address - Fax:706-596-1767
Practice Address - Street 1:2422 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2741
Practice Address - Country:US
Practice Address - Phone:706-596-1757
Practice Address - Fax:706-596-1767
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0151511223S0112X
WV184781223S0112X
WV991223S0112X
AL43491223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN015151OtherDENTIST LICENSE
WVG40435Medicare UPIN
WVAL0815042Medicare ID - Type Unspecified
WV8000018000Medicaid