Provider Demographics
NPI:1447444641
Name:LEONARD, JOHN P (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
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 1:326 S MARSHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3212
Mailing Address - Country:US
Mailing Address - Phone:312-942-0200
Mailing Address - Fax:312-666-4640
Practice Address - Street 1:326 S MARSHFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3212
Practice Address - Country:US
Practice Address - Phone:312-942-0200
Practice Address - Fax:312-666-4640
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist