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General NPI Number Information
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NPI Number | 1013396365
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Entity Type | Individual
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Provider Name | BRIAN LEONG DMD
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Gender | Male
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Dates
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Enumeration Date | 05/20/2015
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 13655 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75240-4721
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Country | US
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Telephone | 347-860-0087
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 W 4TH ST
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City | BROOKLYN
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State | NY
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Zip | 11204-4936
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Country | US
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Telephone | 347-860-0087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 058506
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 31913
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License Number State | TX
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