Healthcare Provider Details

I. General information

NPI: 1558146191
Provider Name (Legal Business Name): LEANDRO PETRELLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9221 CHAMBERLAYNE RD
MECHANICSVILLE VA
23116-2511
US

IV. Provider business mailing address

9221 CHAMBERLAYNE RD
MECHANICSVILLE VA
23116-2511
US

V. Phone/Fax

Practice location:
  • Phone: 804-427-7420
  • Fax:
Mailing address:
  • Phone: 804-427-7420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401418597
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418597
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: