Provider Demographics
NPI:1912007295
Name:LEBLANC, KELLY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:M
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8678 LOUETTA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:281-376-3959
Mailing Address - Fax:281-257-1070
Practice Address - Street 1:8678 LOUETTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:281-376-3959
Practice Address - Fax:281-257-1070
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist