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General NPI Number Information
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NPI Number | 1316030497
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Entity Type | Organization
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Legal Business Name | MANUEL DELEON DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/05/2015
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Provider Practice Location Address
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Address Line | 8932 WOODMAN AVE STE 101
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City | ARLETA
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State | CA
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Zip | 91331
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Country | US
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Telephone | 818-895-1458
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Fax | 818-982-3492
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Provider Business Mailing Address
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Address Line | 8932 WOODMAN AVE STE 101
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City | ARLETA
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State | CA
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Zip | 91331
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Country | US
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Telephone | 818-895-1458
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Fax | 818-982-3492
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Authorized Official
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Title or Position | PRESIDENT
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Name | MANUEL ANTONIO DE LEON
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Credential | DDS
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Telephone | 818-895-1458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN12447
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30997
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License Number State | CA
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