Provider Demographics
NPI:1649467465
Name:DELEONARDO, ROSS STANLEY SR (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:STANLEY
Last Name:DELEONARDO
Suffix:SR
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 1:203 BROAD ST
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4751
Mailing Address - Country:US
Mailing Address - Phone:203-878-9444
Mailing Address - Fax:203-876-7057
Practice Address - Street 1:203 BROAD ST
Practice Address - Street 2:SUITE C-1
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4751
Practice Address - Country:US
Practice Address - Phone:203-878-9444
Practice Address - Fax:203-876-7057
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice