Provider Demographics
NPI:1114925690
Name:LEON, LAURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:LEON
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 1:2970 NAU AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-3377
Mailing Address - Country:US
Mailing Address - Phone:714-832-2732
Mailing Address - Fax:
Practice Address - Street 1:314 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6049
Practice Address - Country:US
Practice Address - Phone:714-774-4443
Practice Address - Fax:714-563-8276
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45905-01OtherDENTI-CAL ID NUMBER