Provider Demographics
NPI:1316030497
Name:MANUEL DELEON DDS A DENTAL CORPORATION
Entity Type:Organization
Organization Name:MANUEL DELEON DDS A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-895-1458
Mailing Address - Street 1:8932 WOODMAN AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331
Mailing Address - Country:US
Mailing Address - Phone:818-895-1458
Mailing Address - Fax:818-982-3492
Practice Address - Street 1:8932 WOODMAN AVE
Practice Address - Street 2:STE 101
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331
Practice Address - Country:US
Practice Address - Phone:818-895-1458
Practice Address - Fax:818-982-3492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30997122300000X
FLDN12447122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty