Provider Demographics
NPI:1417952383
Name:LEONG, WAYNE S H (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S H
Last Name:LEONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PUUHONU PL
Mailing Address - Street 2:STE 201
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2010
Mailing Address - Country:US
Mailing Address - Phone:808-935-3552
Mailing Address - Fax:808-935-0241
Practice Address - Street 1:82 PUUHONU PL
Practice Address - Street 2:STE 201
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-935-3552
Practice Address - Fax:808-935-0241
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-16871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice