MEDICARE: CHRISTOPHER W. LEYSTER, DDS, A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1417513987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER W. LEYSTER, DDS, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	12328 CHERRY GROVE ST
Second Line	:
City	:	MOORPARK
State	:	CA
Zip	:	93021-3111
Country	:	US
Telephone Number	:	360-701-9126
Fax Number	:

Provider Business Practice Location Address
First Line	:	3991 GRAND AVE STE D
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-5442
Country	:	US
Telephone Number	:	909-591-0077
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER LEYSTER
Credential	:	DDS
Telephone Number	:	360-701-9126

Provider Enumeration Date	:	05/10/2019
Last Update Date	:	05/10/2019

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