Healthcare Provider Details

I. General information

NPI: 1346020880
Provider Name (Legal Business Name): MARIA FERNANDA LEAL CARDENAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 LINCOLN WAY E STE E
MASSILLON OH
44646-7084
US

IV. Provider business mailing address

2020 LINCOLN WAY E STE E
MASSILLON OH
44646-7084
US

V. Phone/Fax

Practice location:
  • Phone: 330-830-5300
  • Fax:
Mailing address:
  • Phone: 323-540-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30028475
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: