Healthcare Provider Details

I. General information

NPI: 1174446769
Provider Name (Legal Business Name): LEON DENNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 ANNAPOLIS RD STE A3
LANHAM MD
20706-2060
US

IV. Provider business mailing address

826 ROXBURY CT
WALDORF MD
20602-2822
US

V. Phone/Fax

Practice location:
  • Phone: 301-658-1968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: