Provider Demographics
NPI:1538183520
Name:LEBLANC, MICHAEL (DDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LEBLANC
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 1:5021 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-2406
Mailing Address - Country:US
Mailing Address - Phone:913-530-3783
Mailing Address - Fax:
Practice Address - Street 1:6850 HILLTOP RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226-3532
Practice Address - Country:US
Practice Address - Phone:913-745-2500
Practice Address - Fax:913-745-2503
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS602661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200328130AMedicaid