Provider Demographics
NPI:1316042062
Name:VEGO, LEROY (DDS MS)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:VEGO
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 LACHMAN LANE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-230-9636
Mailing Address - Fax:310-230-9916
Practice Address - Street 1:UCLA SCHOOL OF DENTISTRY
Practice Address - Street 2:10833 LECONTE AVE 20-140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1668
Practice Address - Country:US
Practice Address - Phone:310-206-1770
Practice Address - Fax:310-206-5349
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics