Provider Demographics
NPI:1316998933
Name:LEON DISCAVAGE, D.D.S., P.A.
Entity type:Organization
Organization Name:LEON DISCAVAGE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DISCAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-871-6660
Mailing Address - Street 1:13975 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2921
Mailing Address - Country:US
Mailing Address - Phone:301-871-6660
Mailing Address - Fax:301-871-7300
Practice Address - Street 1:13975 CONNECTICUT AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-871-6660
Practice Address - Fax:301-871-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD46731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty