Provider Demographics
NPI:1366543126
Name:PIERCE, LEONARD WAYNE (DDS MS PS)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:WAYNE
Last Name:PIERCE
Suffix:
Gender:M
Credentials:DDS MS PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N EMERSON
Mailing Address - Street 2:STE 101
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801
Mailing Address - Country:US
Mailing Address - Phone:509-663-0068
Mailing Address - Fax:509-663-0060
Practice Address - Street 1:620 N EMERSON
Practice Address - Street 2:STE 101
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801
Practice Address - Country:US
Practice Address - Phone:509-663-0068
Practice Address - Fax:509-663-0060
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5008073Medicaid
U24199Medicare UPIN
WA5008073Medicaid