Provider Demographics
NPI:1356408462
Name:BROVERMAN, LEONARD BARNETT (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:BARNETT
Last Name:BROVERMAN
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 1:45 WEBSTER CIR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1275
Mailing Address - Country:US
Mailing Address - Phone:978-443-2636
Mailing Address - Fax:978-443-2637
Practice Address - Street 1:290 BAKER AVE
Practice Address - Street 2:S101
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2189
Practice Address - Country:US
Practice Address - Phone:978-369-2062
Practice Address - Fax:978-369-0090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA112231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice