Provider Demographics
NPI:1992414353
Name:LEONARD, JESSICA N (EPRDH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:LEONARD
Suffix:
Gender:F
Credentials:EPRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23120 SW GREENGATE PL
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-6307
Mailing Address - Country:US
Mailing Address - Phone:503-753-4149
Mailing Address - Fax:
Practice Address - Street 1:7460 SW HUNZIKER RD STE H
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8244
Practice Address - Country:US
Practice Address - Phone:503-521-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4798124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist