Healthcare Provider Details

I. General information

NPI: 1922091800
Provider Name (Legal Business Name): LEONARD JAMES PLAITANO D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST DENTAL BN/ NDC BOX 55521
CAMP PENDLETON CA
92055-5221
US

IV. Provider business mailing address

26 HYDRANGEA ST
LADERA RANCH CA
92694-0843
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7455
  • Fax:
Mailing address:
  • Phone: 949-310-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number51438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: