Provider Demographics
NPI:1477542975
Name:CONKLING, LEON A (DDS)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:A
Last Name:CONKLING
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 1:3701 N KICKAPOO AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1703
Mailing Address - Country:US
Mailing Address - Phone:405-275-1876
Mailing Address - Fax:405-275-1143
Practice Address - Street 1:3701 N KICKAPOO AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1703
Practice Address - Country:US
Practice Address - Phone:405-275-1876
Practice Address - Fax:405-275-1143
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist