MEDICARE: DR. LEONCIO NIKOLAY FIERRO DDS

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	122300000X	Dentist	64529	CA

General Provider Information

NPI Number	:	1447636527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONCIO NIKOLAY FIERRO DDS

Provider Business Mailing Address
First Line	:	33215 MISSION BLVD
Second Line	:	APT. B-222
City	:	UNION CITY
State	:	CA
Zip	:	94587-1449
Country	:	US
Telephone Number	:	510-228-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 ROSS AVE STE 305
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3039
Country	:	US
Telephone Number	:	408-317-0162
Fax Number	:	510-405-9303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	03/01/2022

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