Provider Demographics
NPI:1184714875
Name:LEONARD, G. GALIA (MD, DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:GALIA
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD, DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 357131
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7131
Mailing Address - Country:US
Mailing Address - Phone:206-543-7722
Mailing Address - Fax:206-685-7222
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:B241 HSB
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7134
Practice Address - Country:US
Practice Address - Phone:206-543-7722
Practice Address - Fax:206-685-7222
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000090661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0175774OtherL&I
WA5036488Medicaid
WAV00070Medicare UPIN