Provider Demographics
NPI:1114672342
Name:INFINITY DENTAL GROUP
Entity Type:Organization
Organization Name:INFINITY DENTAL GROUP
Other - Org Name:LEONCIO N FIERRO, D.D.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONCIO
Authorized Official - Middle Name:NIKOLAY
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-317-0162
Mailing Address - Street 1:3535 ROSS AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3039
Mailing Address - Country:US
Mailing Address - Phone:408-317-0169
Mailing Address - Fax:510-405-9303
Practice Address - Street 1:3535 ROSS AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3039
Practice Address - Country:US
Practice Address - Phone:408-317-0169
Practice Address - Fax:510-405-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental