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General NPI Number Information
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NPI Number | 1285754465
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Entity Type | Organization
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Legal Business Name | JOSE MARIO LEON-FRIAS
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | AV. LOPEZ MATEOS 171-2 PLAZA AZTECA
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City | NOGALES
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State | SONORA
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Zip | 84000
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Country | MX
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Telephone | 631-312-5544
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Fax | 631-312-5545
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Provider Business Mailing Address
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Address Line | P.O. BOX 2722
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City | NOGALES
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State | AZ
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Zip | 85628-2722
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Country | US
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Telephone | 644-414-5533
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE MARIO LEON-FRIAS
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Credential | DDS, MSCD
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Telephone | 644-414-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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