Provider Demographics
NPI:1417173238
Name:LEONG, DONNA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:LEONG
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 1:255 N SAN MATEO DR STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2671
Mailing Address - Country:US
Mailing Address - Phone:650-344-1183
Mailing Address - Fax:
Practice Address - Street 1:255 N SAN MATEO DR STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2671
Practice Address - Country:US
Practice Address - Phone:650-344-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice