Provider Demographics
NPI:1245323286
Name:DE LEEUW, RINSKJE (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:RINSKJE
Middle Name:
Last Name:DE LEEUW
Suffix:
Gender:F
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:D104
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-5500
Mailing Address - Fax:
Practice Address - Street 1:UK OROFACIAL PAIN CLINIC
Practice Address - Street 2:740 S LIMESTONE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536
Practice Address - Country:US
Practice Address - Phone:859-323-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60070703Medicaid
KY60070703Medicaid
KYU85003Medicare UPIN