Healthcare Provider Details

I. General information

NPI: 1326098088
Provider Name (Legal Business Name): LEON VILNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST SUITE 321
DENVER CO
80224-2549
US

IV. Provider business mailing address

9366 E ASBURY PL
DENVER CO
80231-5741
US

V. Phone/Fax

Practice location:
  • Phone: 303-796-8767
  • Fax:
Mailing address:
  • Phone: 303-338-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7816
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: