Provider Demographics
NPI:1881734085
Name:LEONARD, LEON JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:JAMES
Last Name:LEONARD
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 1:1455 OLD MCDONOUGH HWY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5979
Mailing Address - Country:US
Mailing Address - Phone:770-922-4300
Mailing Address - Fax:
Practice Address - Street 1:1455 OLD MCDONOUGH HWY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5979
Practice Address - Country:US
Practice Address - Phone:770-922-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0096451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics