Provider Demographics
NPI:1376601211
Name:DE LEON, MARIA PATROCINIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:PATROCINIO
Last Name:DE LEON
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 1:1942 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2669
Mailing Address - Country:US
Mailing Address - Phone:949-631-1000
Mailing Address - Fax:949-631-0350
Practice Address - Street 1:1942 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2669
Practice Address - Country:US
Practice Address - Phone:949-631-1000
Practice Address - Fax:949-631-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1879369OtherUNITED CONCORDIA
CAG-94004-01OtherDENTICAL
BD6074912OtherDEA