Provider Demographics
NPI:1194975714
Name:LEONARD, DAVID LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:LEONARD
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 1:6600 FRANCE AVE S STE 415
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1817
Mailing Address - Country:US
Mailing Address - Phone:952-224-9771
Mailing Address - Fax:952-224-9790
Practice Address - Street 1:3015 HIGHWAY 29 S STE 4176
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-4540
Practice Address - Country:US
Practice Address - Phone:320-763-5052
Practice Address - Fax:320-763-5053
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN207320000Medicaid