Provider Demographics
NPI:1205040490
Name:WILKINS, LEONA (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:LEONA
Middle Name:
Last Name:WILKINS
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21337 39TH AVE
Mailing Address - Street 2:STE 226
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2071
Mailing Address - Country:US
Mailing Address - Phone:917-756-4499
Mailing Address - Fax:
Practice Address - Street 1:21337 39TH AVE
Practice Address - Street 2:STE 226
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2071
Practice Address - Country:US
Practice Address - Phone:917-756-4499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0547211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics