Provider Demographics
NPI:1003917345
Name:LEYBA, MA. LOIDA SERRANO (DMD)
Entity Type:Individual
Prefix:MS
First Name:MA. LOIDA
Middle Name:SERRANO
Last Name:LEYBA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:LOIDA
Other - Middle Name:S
Other - Last Name:LEYBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:8696 ELK GROVE BLVD
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-3301
Mailing Address - Country:US
Mailing Address - Phone:916-685-5244
Mailing Address - Fax:916-685-1483
Practice Address - Street 1:8696 ELK GROVE BLVD
Practice Address - Street 2:SUITE # 8
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-3301
Practice Address - Country:US
Practice Address - Phone:916-685-5244
Practice Address - Fax:916-685-1483
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice