Provider Demographics
NPI:1821005133
Name:LEONARD, TIMOTHY WERNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WERNER
Last Name:LEONARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 WEST SECOND STREET PO 217
Mailing Address - Street 2:SUITE #B
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056
Mailing Address - Country:US
Mailing Address - Phone:606-564-3375
Mailing Address - Fax:606-564-3375
Practice Address - Street 1:123 WEST SECOND STREET PO 217
Practice Address - Street 2:SUITE #B
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056
Practice Address - Country:US
Practice Address - Phone:606-564-3375
Practice Address - Fax:606-564-3375
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60047180Medicaid