Provider Demographics
NPI:1063584910
Name:LEONOFF, DAVID ROSS (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROSS
Last Name:LEONOFF
Suffix:
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 1:469 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4276
Mailing Address - Country:US
Mailing Address - Phone:631-369-5300
Mailing Address - Fax:631-369-2481
Practice Address - Street 1:469 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:LAKE RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4276
Practice Address - Country:US
Practice Address - Phone:631-588-8280
Practice Address - Fax:631-588-6258
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0457381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist