Provider Demographics
NPI:1770672669
Name:LEAHY, KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:LEAHY
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 1:1500 TOWN SIDE DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502
Mailing Address - Country:US
Mailing Address - Phone:919-363-4204
Mailing Address - Fax:919-363-4207
Practice Address - Street 1:1500 TOWN SIDE DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502
Practice Address - Country:US
Practice Address - Phone:919-363-4204
Practice Address - Fax:919-363-4207
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice