Provider Demographics
NPI:1396834362
Name:LEBLANC, MARC ERNEST (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ERNEST
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44853 PORTOLA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-3703
Mailing Address - Country:US
Mailing Address - Phone:760-346-1414
Mailing Address - Fax:760-346-7335
Practice Address - Street 1:44853 PORTOLA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3703
Practice Address - Country:US
Practice Address - Phone:760-346-1414
Practice Address - Fax:760-346-7335
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200418543OtherTAX ID #