Provider Demographics
NPI:1386204568
Name:LEONCE, KENI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENI
Middle Name:
Last Name:LEONCE
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 1:11455 CANAL XING
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6747
Mailing Address - Country:US
Mailing Address - Phone:912-217-4953
Mailing Address - Fax:
Practice Address - Street 1:1936 W RIVER RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24590-4880
Practice Address - Country:US
Practice Address - Phone:434-286-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158711223G0001X
VA0401418503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice