Healthcare Provider Details

I. General information

NPI: 1477961654
Provider Name (Legal Business Name): LEONARD FIUME D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 MCCARTHY BLVD.
NEW BERN NC
28562
US

IV. Provider business mailing address

608 MCCARTHY BLVD.
NEW BERN NC
28562
US

V. Phone/Fax

Practice location:
  • Phone: 252-636-1900
  • Fax:
Mailing address:
  • Phone: 252-636-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9765
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: