Provider Demographics
NPI:1497415491
Name:LEIGHTON M. KENNEDY, DMD, PLLC
Entity Type:Organization
Organization Name:LEIGHTON M. KENNEDY, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-601-6731
Mailing Address - Street 1:19920 SCANMAR LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6305
Mailing Address - Country:US
Mailing Address - Phone:336-601-6731
Mailing Address - Fax:
Practice Address - Street 1:134 PROFESSIONAL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5600
Practice Address - Country:US
Practice Address - Phone:704-799-0377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-19
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty