Provider Demographics
NPI:1215348412
Name:LEONG, AUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:LEONG
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 1:1793 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2148
Mailing Address - Country:US
Mailing Address - Phone:856-424-7177
Mailing Address - Fax:
Practice Address - Street 1:1793 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2148
Practice Address - Country:US
Practice Address - Phone:856-424-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-12
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572431223P0700X
NJ22DI026174001223P0700X
PADS0409321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics