Healthcare Provider Details

I. General information

NPI: 1326234311
Provider Name (Legal Business Name): DR. LEONARD L. RADNOR DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 WATERDAM RD SUITE 140
MC MURRAY PA
15317-2573
US

IV. Provider business mailing address

157 WATERDAM RD SUITE 140
MC MURRAY PA
15317-2573
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-3570
  • Fax: 724-941-2988
Mailing address:
  • Phone: 724-941-3570
  • Fax: 724-941-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS027734L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier734382
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNITED CONCORDIA PROVIDER

VIII. Authorized Official

Name: DR. LEONARD L RADNOR
Title or Position: DR./OWNER
Credential: DMD
Phone: 724-941-3570