Provider Demographics
NPI:1992923197
Name:COVERLY, LEON K (DDS)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:K
Last Name:COVERLY
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 1:174 S LAKE DOSTER DR
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9117
Mailing Address - Country:US
Mailing Address - Phone:269-685-6481
Mailing Address - Fax:
Practice Address - Street 1:2131 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2302
Practice Address - Country:US
Practice Address - Phone:269-344-8988
Practice Address - Fax:269-344-2565
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010085621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics