Provider Demographics
NPI:1912906603
Name:MEDURA, LEONARD CARL SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:CARL
Last Name:MEDURA
Suffix:SR
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 1:21 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1341
Mailing Address - Country:US
Mailing Address - Phone:570-675-1138
Mailing Address - Fax:570-675-2152
Practice Address - Street 1:1 TARLETON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1248
Practice Address - Country:US
Practice Address - Phone:570-675-1138
Practice Address - Fax:570-675-2152
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017342L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice