Provider Demographics
NPI:1477828432
Name:CARLOS Y LEAL DDS II INC
Entity Type:Organization
Organization Name:CARLOS Y LEAL DDS II INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-204-0643
Mailing Address - Street 1:659 E. 15 ST SUITE B
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-946-8304
Mailing Address - Fax:909-946-8394
Practice Address - Street 1:659 E. 15 ST SUITE B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-946-8304
Practice Address - Fax:909-946-8394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADT32249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty