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General NPI Number Information
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NPI Number | 1720468929
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Entity Type | Organization
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Legal Business Name | ESDL DE LEON DDS INC
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 1375 B ST
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City | HAYWARD
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State | CA
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Zip | 94541-2917
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Country | US
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Telephone | 510-582-8277
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Fax | 510-582-0305
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Provider Business Mailing Address
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Address Line | 1375 B ST
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City | HAYWARD
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State | CA
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Zip | 94541-2917
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Country | US
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Telephone | 510-582-8277
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Fax | 510-582-0305
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELMER SANTOS DE LEON
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Credential | DDS
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Telephone | 510-396-2703
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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 | 55619
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License Number State | CA
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