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General NPI Number Information
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NPI Number | 1912778960
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Entity Type | Organization
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Legal Business Name | LEONI DENTAL CORPORATION
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 31897 DEL OBISPO ST STE 100
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3207
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Country | US
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Telephone | 760-500-6197
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Fax |
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Provider Business Mailing Address
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Address Line | 31897 DEL OBISPO ST STE 100
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3207
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Country | US
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Telephone | 949-661-2290
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Fax | 949-661-8433
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | RANDAL LEONI
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Credential | DMD
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Telephone | 760-500-6197
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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 |
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License Number State |
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