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General NPI Number Information
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NPI Number | 1043422504
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Entity Type | Individual
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Provider Name | LELAND F PORTEOUS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9500 CROW CANYON RD STE. A
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City | DANVILLE
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State | CA
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Zip | 94506-1188
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Country | US
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Telephone | 925-736-1661
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Fax | 925-648-7307
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Provider Business Mailing Address
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Address Line | 421 BENT OAK PL
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City | DANVILLE
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State | CA
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Zip | 94506-5823
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Country | US
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Telephone | 925-736-1661
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Fax | 925-648-7307
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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 | 29131
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License Number State | CA
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