Provider Demographics
NPI:1326254350
Name:MAGLILONG, LEONILA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONILA
Middle Name:S
Last Name:MAGLILONG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W 56TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3831
Mailing Address - Country:US
Mailing Address - Phone:212-875-1489
Mailing Address - Fax:
Practice Address - Street 1:162 W 56TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3831
Practice Address - Country:US
Practice Address - Phone:212-875-1489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist