Provider Demographics
NPI:1396810818
Name:LEONG, PENNY M (DMD)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:M
Last Name:LEONG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 41ST AVE SW
Mailing Address - Street 2:#322
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4567
Mailing Address - Country:US
Mailing Address - Phone:425-413-8505
Mailing Address - Fax:425-413-8144
Practice Address - Street 1:23866 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-413-8505
Practice Address - Fax:425-413-8144
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice