Provider Demographics
NPI:1174588248
Name:VONWALD, LEIGH (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:
Last Name:VONWALD
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442
Mailing Address - Street 2:HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:US
Mailing Address - Phone:622-117-2728
Mailing Address - Fax:
Practice Address - Street 1:CMR 442
Practice Address - Street 2:HEIDELBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:US
Practice Address - Phone:622-117-2728
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics