Provider Demographics
NPI:1952697815
Name:DR. DALE M. LEONHARDT DDS INC
Entity Type:Organization
Organization Name:DR. DALE M. LEONHARDT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEONHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:330-762-8606
Mailing Address - Street 1:585 WEST EXCHANGE STREET
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302
Mailing Address - Country:US
Mailing Address - Phone:330-762-8606
Mailing Address - Fax:330-762-5554
Practice Address - Street 1:585 WEST EXCHANGE STREET
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302
Practice Address - Country:US
Practice Address - Phone:330-762-8606
Practice Address - Fax:330-762-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-4604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262433Medicaid