Provider Demographics
NPI:1811988538
Name:INFRANCO, LEONARD VINCENT (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:VINCENT
Last Name:INFRANCO
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 1:701 YALE TER
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5818
Mailing Address - Country:US
Mailing Address - Phone:856-692-8300
Mailing Address - Fax:856-692-9229
Practice Address - Street 1:701 YALE TER
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5818
Practice Address - Country:US
Practice Address - Phone:856-692-8300
Practice Address - Fax:856-692-9229
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021066001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMEDICAIDMedicaid
NJ051828ATNMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO
NJU87542Medicare UPIN