Provider Demographics
NPI:1902796402
Name:LEON, KENIA GISELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:KENIA
Middle Name:GISELLE
Last Name:LEON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23350 N 23RD AVE UNIT 7036
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-0029
Mailing Address - Country:US
Mailing Address - Phone:928-920-7143
Mailing Address - Fax:
Practice Address - Street 1:3425 W THUNDERBIRD RD STE 13
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-5670
Practice Address - Country:US
Practice Address - Phone:480-916-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist