Provider Demographics
NPI:1316208077
Name:KENNEDY, LEIGHTON MARGARET (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEIGHTON
Middle Name:MARGARET
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LEE ANN DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2911
Mailing Address - Country:US
Mailing Address - Phone:704-795-1055
Mailing Address - Fax:704-795-6743
Practice Address - Street 1:1020 LEE ANN DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2911
Practice Address - Country:US
Practice Address - Phone:704-795-1055
Practice Address - Fax:704-795-6743
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9302122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist