Provider Demographics
NPI:1144550542
Name:WAYNE S H LEONG, DDS, INC.
Entity type:Organization
Organization Name:WAYNE S H LEONG, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S H
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-935-3552
Mailing Address - Street 1:82 PUUHONU PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2010
Mailing Address - Country:US
Mailing Address - Phone:808-935-3552
Mailing Address - Fax:808-935-0241
Practice Address - Street 1:82 PUUHONU PL
Practice Address - Street 2:SUITE 201
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-935-3552
Practice Address - Fax:808-935-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 16871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty