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General NPI Number Information
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NPI Number | 1982750261
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Entity Type | Organization
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Legal Business Name | JAMES WAYNE LEONARD, D.M.D., P.A.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 563 UNIVERSITY BLVD N
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7035
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Country | US
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Telephone | 904-724-7190
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Fax | 904-224-0027
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Provider Business Mailing Address
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Address Line | 563 UNIVERSITY BLVD N
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City | JACKSONVILLE
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State | FL
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Zip | 32211-7035
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Country | US
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Telephone | 904-724-7190
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Fax | 904-224-0027
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES WAYNE LEONARD JR.
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Credential | DMD
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Telephone | 904-724-7190
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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 | DN0014607
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License Number State | FL
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