MEDICARE: LEON DISCAVAGE, D.D.S., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4673	MD

General Provider Information

NPI Number	:	1316998933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON DISCAVAGE, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	13975 CONNECTICUT AVE
Second Line	:	SUITE 302
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2921
Country	:	US
Telephone Number	:	301-871-6660
Fax Number	:	301-871-7300

Provider Business Practice Location Address
First Line	:	13975 CONNECTICUT AVE
Second Line	:	SUITE 302
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2921
Country	:	US
Telephone Number	:	301-871-6660
Fax Number	:	301-871-7300

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. LEON ROBERT DISCAVAGE
Credential	:	D.D.S.
Telephone Number	:	301-871-6660

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/11/2008

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