Provider Demographics
NPI:1972823045
Name:LEONARD, KAITLIN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:MARIE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3811
Mailing Address - Country:US
Mailing Address - Phone:810-434-4839
Mailing Address - Fax:
Practice Address - Street 1:522 MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3811
Practice Address - Country:US
Practice Address - Phone:810-987-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010202131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice