Provider Demographics
NPI:1255670832
Name:LEONCHIK, INNA ANATOLYEVNA (RDH)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:ANATOLYEVNA
Last Name:LEONCHIK
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5493 AMY ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3320
Mailing Address - Country:US
Mailing Address - Phone:503-710-9839
Mailing Address - Fax:
Practice Address - Street 1:5493 AMY ST
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3320
Practice Address - Country:US
Practice Address - Phone:503-710-9839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-02
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6307124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist