Provider Demographics
NPI:1528353562
Name:CARNEIRO, LEANDRO G (DDS)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:G
Last Name:CARNEIRO
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 1:1339 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-3007
Mailing Address - Country:US
Mailing Address - Phone:617-756-3903
Mailing Address - Fax:518-393-1612
Practice Address - Street 1:1339 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3007
Practice Address - Country:US
Practice Address - Phone:617-756-3903
Practice Address - Fax:518-393-1612
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY0590191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program