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General NPI Number Information
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NPI Number | 1891493961
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Entity Type | Organization
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Legal Business Name | KRISTEN LEONG, DMD, LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 3901 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3133
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Country | US
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Telephone | 215-662-1030
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Fax | 215-662-1015
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Provider Business Mailing Address
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Address Line | 3901 MARKET ST STE 1936
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City | PHILADELPHIA
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State | PA
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Zip | 19104-3192
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KRISTEN LEONG
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Credential | DMD
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Telephone | 267-294-7915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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