Provider Demographics
NPI:1336100684
Name:RADNOR, LEONARD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:L
Last Name:RADNOR
Suffix:
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 1:157 WATERDAM RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2573
Mailing Address - Country:US
Mailing Address - Phone:724-941-3570
Mailing Address - Fax:724-941-2988
Practice Address - Street 1:157 WATERDAM RD
Practice Address - Street 2:SUITE 140
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2573
Practice Address - Country:US
Practice Address - Phone:724-941-3570
Practice Address - Fax:724-941-2988
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027734L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA734382OtherUNITED CONCORDIA PROVIDER
PA734382OtherUNITED CONCORDIA PROVIDER