Provider Demographics
NPI:1750553038
Name:THANOS, LEANA (DDDS)
Entity type:Individual
Prefix:
First Name:LEANA
Middle Name:
Last Name:THANOS
Suffix:
Gender:F
Credentials:DDDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N COMMERCE PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-389-8887
Mailing Address - Fax:
Practice Address - Street 1:1625 N COMMERCE PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3216
Practice Address - Country:US
Practice Address - Phone:954-389-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL120811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice