Provider Demographics
NPI:1699735050
Name:RIOS-ANDERSEN, LEONARDO MANUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:MANUEL
Last Name:RIOS-ANDERSEN
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 1:12641 OLD GLENN HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7040
Mailing Address - Country:US
Mailing Address - Phone:907-726-5600
Mailing Address - Fax:907-726-5602
Practice Address - Street 1:12641 OLD GLENN HWY STE 103
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7040
Practice Address - Country:US
Practice Address - Phone:907-726-5600
Practice Address - Fax:907-726-5602
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR025581223S0112X
AKDEND14481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery