Provider Demographics
NPI:1326627092
Name:LEONARD, KERRY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:
Last Name:LEONARD
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 1:137 OLD CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-6909
Mailing Address - Country:US
Mailing Address - Phone:386-212-1518
Mailing Address - Fax:
Practice Address - Street 1:137 OLD CARRIAGE RD
Practice Address - Street 2:
Practice Address - City:PONCE INLET
Practice Address - State:FL
Practice Address - Zip Code:32127-6909
Practice Address - Country:US
Practice Address - Phone:386-212-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN255731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice