Provider Demographics
NPI:1043480841
Name:WILLIAM LEON DDS PA
Entity Type:Organization
Organization Name:WILLIAM LEON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-537-7057
Mailing Address - Street 1:6209 42ND AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1603
Mailing Address - Country:US
Mailing Address - Phone:763-537-7057
Mailing Address - Fax:763-535-5038
Practice Address - Street 1:6209 42ND AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-1603
Practice Address - Country:US
Practice Address - Phone:763-537-7057
Practice Address - Fax:763-535-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND120011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty