Provider Demographics
NPI:1982750261
Name:JAMES WAYNE LEONARD, D.M.D., P.A.
Entity Type:Organization
Organization Name:JAMES WAYNE LEONARD, D.M.D., P.A.
Other - Org Name:J. WAYNE LEONARD, D.M.D., P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-724-7190
Mailing Address - Street 1:563 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-7035
Mailing Address - Country:US
Mailing Address - Phone:904-724-7190
Mailing Address - Fax:904-224-0027
Practice Address - Street 1:563 UNIVERSITY BLVD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-7035
Practice Address - Country:US
Practice Address - Phone:904-724-7190
Practice Address - Fax:904-224-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00146071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty