Provider Demographics
NPI:1437285905
Name:GRISANTI, LEONELLO PATRICK II (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONELLO
Middle Name:PATRICK
Last Name:GRISANTI
Suffix:II
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 1:2504 RIDGE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:972-772-9505
Mailing Address - Fax:972-722-7506
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-772-9505
Practice Address - Fax:972-722-7506
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice