Healthcare Provider Details

I. General information

NPI: 1174439228
Provider Name (Legal Business Name): DR. GINA A DELEONIBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2384 SOUTHEAST BLVD
SALEM OH
44460-3418
US

IV. Provider business mailing address

5484 RENEE DR
HIGHLAND HEIGHTS OH
44143-3027
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-0368
  • Fax:
Mailing address:
  • Phone: 410-991-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30.028593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: