Healthcare Provider Details

I. General information

NPI: 1023931474
Provider Name (Legal Business Name): LASTING SMILES BY LEANDRA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 PALOS VERDES MALL # 174
WALNUT CREEK CA
94597-2228
US

IV. Provider business mailing address

1547 PALOS VERDES MALL # 174
WALNUT CREEK CA
94597-2228
US

V. Phone/Fax

Practice location:
  • Phone: 707-595-0141
  • Fax:
Mailing address:
  • Phone: 707-595-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: LEANDRA SOLOMON
Title or Position: HYGIENIST
Credential: RDHAP
Phone: 707-595-0141