Healthcare Provider Details

I. General information

NPI: 1699337501
Provider Name (Legal Business Name): STEVEN LEROY II DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SOLANO AVE STE 101
ALBANY CA
94706-1825
US

IV. Provider business mailing address

7516 POTRERO AVE
EL CERRITO CA
94530-2020
US

V. Phone/Fax

Practice location:
  • Phone: 510-528-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number111010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: