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NPI Code Detail

MEDICARE: MISS SAMANTHA KEITH DE LEON D.D.S.

MEDICARE: MISS SAMANTHA KEITH DE LEON D.D.S.
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
1122300000XDentistDDS100732CA
21223G0001XGeneral Practice DentistryDDS100732CA

General Provider Information

NPI Number : 1831640523
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS SAMANTHA KEITH DE LEON D.D.S.
Provider Business Mailing Address
First Line : 207 E CITY PLACE DR
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-6011
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 715 S MAIN ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92701-5717
Country : US
Telephone Number : 714-835-6616
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2016
Last Update Date : 10/18/2016

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