Provider Demographics
NPI:1518643717
Name:PELAEZ LEON, ARIANNA (DMD)
Entity Type:Individual
Prefix:
First Name:ARIANNA
Middle Name:
Last Name:PELAEZ LEON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 DAVIE RD APT 414
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1635
Mailing Address - Country:US
Mailing Address - Phone:786-899-9415
Mailing Address - Fax:
Practice Address - Street 1:9132 STRADA PL STE 11101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2968
Practice Address - Country:US
Practice Address - Phone:239-206-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice