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General NPI Number Information
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NPI Number | 1164429338
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Entity Type | Individual
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Provider Name | LESLIE HATA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2005
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 5277 COLLEGE AVE SUITE 106
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City | OAKLAND
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State | CA
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Zip | 94618-1437
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Country | US
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Telephone | 510-653-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 5277 COLLEGE AVE SUITE 106
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City | OAKLAND
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State | CA
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Zip | 94618-1437
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Country | US
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Telephone | 510-653-7012
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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 | 31795
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License Number State | CA
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