Provider Demographics
NPI:1043422504
Name:PORTEOUS, LELAND F (DDS)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:F
Last Name:PORTEOUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 BENT OAK PL
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-5823
Mailing Address - Country:US
Mailing Address - Phone:925-736-1661
Mailing Address - Fax:925-648-7307
Practice Address - Street 1:9500 CROW CANYON RD
Practice Address - Street 2:STE. A
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-1188
Practice Address - Country:US
Practice Address - Phone:925-736-1661
Practice Address - Fax:925-648-7307
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice