Provider Demographics
NPI:1669257523
Name:LEONG, KENNETH (DDS)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:LEONG
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 1:325 HOSPITAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5806
Mailing Address - Country:US
Mailing Address - Phone:410-768-4488
Mailing Address - Fax:
Practice Address - Street 1:325 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5806
Practice Address - Country:US
Practice Address - Phone:410-768-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist