MEDICARE: KELLY LEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	135678	AK

General Provider Information

NPI Number	:	1083098230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LEACH

Provider Business Mailing Address
First Line	:	10000 CRAIG CREEK CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-6905
Country	:	US
Telephone Number	:	480-228-9562
Fax Number	:

Provider Business Practice Location Address
First Line	:	9138 ARLON ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3876
Country	:	US
Telephone Number	:	907-222-2483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	03/05/2026

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Directions to “ KELLY LEACH ” Practice Location

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