Provider Demographics
NPI:1043332596
Name:REGALADO, MARIA CAROLINA DE LEON (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA CAROLINA
Middle Name:DE LEON
Last Name:REGALADO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21010 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2126
Mailing Address - Country:US
Mailing Address - Phone:562-402-9196
Mailing Address - Fax:562-402-9186
Practice Address - Street 1:21010 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-2126
Practice Address - Country:US
Practice Address - Phone:562-402-9196
Practice Address - Fax:562-402-9186
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice