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General NPI Number Information
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NPI Number | 1376761502
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Entity Type | Individual
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Provider Name | LEONARD TATRO JR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 272 DOGWOOD DRIVE
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City | BIG STONE GAP
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State | VA
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Zip | 24219
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Country | US
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Telephone | 276-523-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 3744 ARROWHEAD TRL
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City | KINGSPORT
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State | TN
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Zip | 37664-2102
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410170
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS0000007588
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License Number State | TN
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