Provider Demographics
NPI:1154472025
Name:RODA, LEON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:RODA
Suffix:III
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 1:100 FRENCH BAR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2557
Mailing Address - Country:US
Mailing Address - Phone:209-223-2712
Mailing Address - Fax:209-223-2719
Practice Address - Street 1:100 FRENCH BAR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2557
Practice Address - Country:US
Practice Address - Phone:209-223-2712
Practice Address - Fax:209-223-2719
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA417811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice