MEDICARE: DR. MARC ERNEST LEBLANC D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36169	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200418543	OTHER	CA	TAX ID #

General Provider Information

NPI Number	:	1396834362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ERNEST LEBLANC D.D.S.

Provider Business Mailing Address
First Line	:	44853 PORTOLA AVE
Second Line	:	SUITE B
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3703
Country	:	US
Telephone Number	:	760-346-1414
Fax Number	:	760-346-7335

Provider Business Practice Location Address
First Line	:	44853 PORTOLA AVE
Second Line	:	SUITE B
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3703
Country	:	US
Telephone Number	:	760-346-1414
Fax Number	:	760-346-7335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/28/2010

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