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General NPI Number Information
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NPI Number | 1750330916
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Entity Type | Individual
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Provider Name | KRISTIN NICOLE LEIS DDS
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 6345 E BELL RD SUITE 1
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-6452
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Country | US
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Telephone | 480-607-3600
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Fax | 480-998-9289
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Provider Business Mailing Address
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Address Line | 1575 BLONDELL AVE SUITE 150
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City | BRONX
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State | NY
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Zip | 10461-2660
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Country | US
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Telephone | 718-405-8190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 049353
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6892
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License Number State | AZ
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