Provider Demographics
NPI:1699937730
Name:GUNNELL, LEIGH ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:ANN
Last Name:GUNNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-0690
Mailing Address - Country:US
Mailing Address - Phone:606-464-0151
Mailing Address - Fax:606-464-0152
Practice Address - Street 1:672 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:KY
Practice Address - Zip Code:41472-1018
Practice Address - Country:US
Practice Address - Phone:606-743-3030
Practice Address - Fax:606-743-7480
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7909OtherLICENSE
KY31000862OtherJUNIPER HEALTH FACILITY MEDICAID
KY7100056720Medicaid