Healthcare Provider Details

I. General information

NPI: 1740352889
Provider Name (Legal Business Name): LILI A LEON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11908 DARNESTOWN RD SUITE F
NORTH POTOMAC MD
20878-2295
US

IV. Provider business mailing address

9832 CANAL RD
MONTGOMERY VILLAGE MD
20886-5101
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-4343
  • Fax: 301-527-4344
Mailing address:
  • Phone: 410-371-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12682
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: