Provider Demographics
NPI:1568168698
Name:BROTHERTON, LENY JOVANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LENY
Middle Name:JOVANA
Last Name:BROTHERTON
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 1:1448 ELEMENTS WAY
Mailing Address - Street 2:UNIT 1448
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-6558
Mailing Address - Country:US
Mailing Address - Phone:305-496-6178
Mailing Address - Fax:
Practice Address - Street 1:8627 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3501
Practice Address - Country:US
Practice Address - Phone:888-226-7479
Practice Address - Fax:323-562-3903
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist