Provider Demographics
NPI:1174569099
Name:WELDON, LEONARD L (DDS)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:L
Last Name:WELDON
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 1:250 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2598
Mailing Address - Country:US
Mailing Address - Phone:603-227-7035
Mailing Address - Fax:603-227-7562
Practice Address - Street 1:272 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4144
Practice Address - Country:US
Practice Address - Phone:603-357-3709
Practice Address - Fax:603-352-5722
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006186Medicaid
NH30011490Medicaid
NHRE4838Medicare ID - Type Unspecified
NH30011490Medicaid