Provider Demographics
NPI:1881737799
Name:LEONARD, WALTER R (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:R
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 1:2445 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1415
Mailing Address - Country:US
Mailing Address - Phone:864-579-7833
Mailing Address - Fax:864-579-8694
Practice Address - Street 1:2445 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1415
Practice Address - Country:US
Practice Address - Phone:864-579-7833
Practice Address - Fax:864-579-8694
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice