Provider Demographics
NPI:1508989930
Name:MUNOZ, ELOY LEANDRO (DDS)
Entity Type:Individual
Prefix:
First Name:ELOY
Middle Name:LEANDRO
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELOY
Other - Middle Name:LEANDRO
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:81118 AVENIDA NEBLINA
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-7891
Mailing Address - Country:US
Mailing Address - Phone:760-600-6645
Mailing Address - Fax:
Practice Address - Street 1:81118 AVENIDA NEBLINA
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-1244
Practice Address - Country:US
Practice Address - Phone:760-600-6645
Practice Address - Fax:760-951-9618
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice