MEDICARE: DR. SOPHIA LEEANA DEVORE 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	DDS113144	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1457045155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA LEEANA DEVORE DDS

Provider Business Mailing Address
First Line	:	13420 ASHCROFT CT
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-3519
Country	:	US
Telephone Number	:	614-359-7069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 E ONTARIO RANCH RD STE 5
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-3920
Country	:	US
Telephone Number	:	909-284-4413
Fax Number	:

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/22/2026

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