Provider Demographics
NPI:1902418726
Name:LEONG, COLLEEN GONG (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:GONG
Last Name:LEONG
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 E BERRY AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2107
Mailing Address - Country:US
Mailing Address - Phone:303-741-3300
Mailing Address - Fax:
Practice Address - Street 1:7447 E BERRY AVE STE 230
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2107
Practice Address - Country:US
Practice Address - Phone:303-741-3300
Practice Address - Fax:303-694-6270
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204501122300000X
CO002045011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist