Provider Demographics
NPI:1861605677
Name:LEONE, MICHAEL H (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:LEONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 KENTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-758-0501
Mailing Address - Fax:330-758-7406
Practice Address - Street 1:825 KENTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-758-0501
Practice Address - Fax:330-758-7406
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300178051223G0001X
OH30-01-78051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5106503Medicaid
OH0893118Medicaid