Provider Demographics
NPI:1770120693
Name:HYMAN, LEONARD GARY (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:GARY
Last Name:HYMAN
Suffix:
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 1:939 MCKENZIE POND RD
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-2564
Mailing Address - Country:US
Mailing Address - Phone:518-891-2426
Mailing Address - Fax:
Practice Address - Street 1:62 BARE HILL RD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2912
Practice Address - Country:US
Practice Address - Phone:518-483-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040599-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist