Provider Demographics
NPI:1477576486
Name:LEAIRD, KELLY HUD (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:HUD
Last Name:LEAIRD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 ROLLING ACRES RD STE 7
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5026
Mailing Address - Country:US
Mailing Address - Phone:352-750-0300
Mailing Address - Fax:352-750-1018
Practice Address - Street 1:918 ROLLING ACRES RD STE 7
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5026
Practice Address - Country:US
Practice Address - Phone:352-750-0300
Practice Address - Fax:352-750-1018
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00141311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice