Provider Demographics
NPI:1912939356
Name:LEONETTI, ROBERT A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LEONETTI
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 1:7 HARKER AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2331
Mailing Address - Country:US
Mailing Address - Phone:856-767-7077
Mailing Address - Fax:856-767-8070
Practice Address - Street 1:7 HARKER AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2331
Practice Address - Country:US
Practice Address - Phone:856-767-7077
Practice Address - Fax:856-767-8070
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013308001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice