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General NPI Number Information
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NPI Number | 1588008163
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Entity Type | Organization
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Legal Business Name | LEON DENTAL CENTER
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 17525 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1519
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Country | US
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Telephone | 954-442-1884
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Fax | 954-432-3368
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Provider Business Mailing Address
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Address Line | 17525 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1519
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Country | US
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Telephone | 954-442-1884
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Fax | 954-432-3368
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MILLIE HERNANDEZ
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Credential |
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Telephone | 954-442-1884
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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 | DN19436
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16579
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN12170
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License Number State | FL
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