Provider Demographics
NPI:1578124525
Name:LEAKE, MARIA KRISTINA (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KRISTINA
Last Name:LEAKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9592 DELIVERY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5515
Mailing Address - Country:US
Mailing Address - Phone:702-606-3584
Mailing Address - Fax:
Practice Address - Street 1:6525 N DECATUR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2993
Practice Address - Country:US
Practice Address - Phone:702-577-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV72531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice