Provider Demographics
NPI:1255487179
Name:TOLSTUNOV, LEONID A (DDS, DMD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:A
Last Name:TOLSTUNOV
Suffix:
Gender:M
Credentials:DDS, DMD
Other - Prefix:DR
Other - First Name:LEN
Other - Middle Name:
Other - Last Name:TOLSTUNOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, DMD
Mailing Address - Street 1:54 CRESTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1633
Mailing Address - Country:US
Mailing Address - Phone:415-730-9140
Mailing Address - Fax:
Practice Address - Street 1:99 W PORTAL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1303
Practice Address - Country:US
Practice Address - Phone:415-661-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405001223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology