Healthcare Provider Details

I. General information

NPI: 1457045155
Provider Name (Legal Business Name): SOPHIA LEEANA DEVORE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 E ONTARIO RANCH RD STE 5
ONTARIO CA
91761-3920
US

IV. Provider business mailing address

13420 ASHCROFT CT
CHINO HILLS CA
91709-3519
US

V. Phone/Fax

Practice location:
  • Phone: 909-284-4413
  • Fax:
Mailing address:
  • Phone: 614-359-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS113144
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: