Provider Demographics
NPI:1164429338
Name:HATA, LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:HATA
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 1:5277 COLLEGE AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1437
Mailing Address - Country:US
Mailing Address - Phone:510-653-7012
Mailing Address - Fax:
Practice Address - Street 1:5277 COLLEGE AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1437
Practice Address - Country:US
Practice Address - Phone:510-653-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-03
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice