Provider Demographics
NPI:1073525499
Name:LEONARD, KEITH G (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:G
Last Name:LEONARD
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 1:17432 SMOKEY POINT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8784
Mailing Address - Country:US
Mailing Address - Phone:360-659-8406
Mailing Address - Fax:360-659-5007
Practice Address - Street 1:17432 SMOKEY POINT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8784
Practice Address - Country:US
Practice Address - Phone:360-659-8406
Practice Address - Fax:360-659-5007
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice