Provider Demographics
NPI:1770630501
Name:LEONARD, PAUL KENT (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:KENT
Last Name:LEONARD
Suffix:
Gender:M
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:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:GRAVETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736-1426
Mailing Address - Country:US
Mailing Address - Phone:479-787-6671
Mailing Address - Fax:
Practice Address - Street 1:KCU ORAL HEALTH CENTER
Practice Address - Street 2:3001 SAINT JOHNS BLVD
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804
Practice Address - Country:US
Practice Address - Phone:417-208-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2916122300000X
MO2024010431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist