Provider Demographics
NPI:1215146410
Name:RILEY, LEONARD P (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:P
Last Name:RILEY
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 1:5912 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1957
Mailing Address - Country:US
Mailing Address - Phone:502-239-0881
Mailing Address - Fax:502-239-0887
Practice Address - Street 1:5912 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1957
Practice Address - Country:US
Practice Address - Phone:502-239-0881
Practice Address - Fax:502-239-0887
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice