Provider Demographics
NPI:1790805174
Name:LEONARD, CARALYN K (DMD)
Entity Type:Individual
Prefix:
First Name:CARALYN
Middle Name:K
Last Name:LEONARD
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 1:10115 CROWN RIDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-8700
Mailing Address - Country:US
Mailing Address - Phone:770-786-9339
Mailing Address - Fax:770-786-8481
Practice Address - Street 1:10115 CROWN RIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-8700
Practice Address - Country:US
Practice Address - Phone:770-786-9339
Practice Address - Fax:770-786-8481
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA98121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice