Provider Demographics
NPI:1700198058
Name:LEIENDECKER, ALAINA PANCIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAINA
Middle Name:PANCIO
Last Name:LEIENDECKER
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 1:1600 W UNIVERSITY AVE
Mailing Address - Street 2:#103
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3114
Mailing Address - Country:US
Mailing Address - Phone:928-774-4400
Mailing Address - Fax:
Practice Address - Street 1:1600 W UNIVERSITY AVE
Practice Address - Street 2:#103
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3114
Practice Address - Country:US
Practice Address - Phone:928-774-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140721223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics