MEDICARE: DR. NICHOLAS EVERETT LEON-GUERRERO 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
1	122300000X	Dentist	058018	NY
2	1223E0200X	Endodontics	0401416454	VA

General Provider Information

NPI Number	:	1972979607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS EVERETT LEON-GUERRERO D.D.S.

Provider Business Mailing Address
First Line	:	2700 S QUINCY ST STE 325
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2242
Country	:	US
Telephone Number	:	703-828-8188
Fax Number	:	703-828-8187

Provider Business Practice Location Address
First Line	:	2700 S QUINCY ST STE 325
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-2242
Country	:	US
Telephone Number	:	703-828-8188
Fax Number	:	703-828-8187

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

Provider Enumeration Date	:	08/17/2015
Last Update Date	:	12/28/2025

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