Individual
DR. LEANDRE DANIEL GERVAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1901 PHOENIX BLVD STE 100, COLLEGE PARK, GA 30349-5062
(770) 991-0913
Mailing address
1000 BLYTHE BLVD, CHARLOTTE, ATLANTA, NC 28203-5812
(704) 355-2165
(704) 355-8856
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN123399
GA
390200000X
Student in an Organized Health Care Education/Training Program
151483
NC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/18/2023
Last updated
06/03/2026
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