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General NPI Number Information
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NPI Number | 1376631648
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Entity Type | Individual
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Provider Name | LEON ARTHUR CERNIWAY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/03/2009
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Provider Practice Location Address
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Address Line | 680 KINGSBOROUGH SQUARE SUITE A
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4988
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Country | US
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Telephone | 757-547-9339
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Fax | 757-547-3433
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Provider Business Mailing Address
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Address Line | 680 KINGSBOROUGH SQUARE SUITE A
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4988
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Country | US
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Telephone | 757-547-9339
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Fax | 757-547-3433
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401006590
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License Number State | VA
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