Provider Demographics
NPI:1356316871
Name:KARDOSH, LEEANN WANDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:WANDA
Last Name:KARDOSH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ENCINITAS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3782
Mailing Address - Country:US
Mailing Address - Phone:760-944-0048
Mailing Address - Fax:760-944-1432
Practice Address - Street 1:531 ENCINITAS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3782
Practice Address - Country:US
Practice Address - Phone:760-944-0048
Practice Address - Fax:623-878-1024
Is Sole Proprietor?:No
Enumeration Date:2006-02-19
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191891223G0001X
AZ87741223E0200X
CA583961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice