Provider Demographics
NPI:1578792248
Name:MASSOUD, LEAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:MASSOUD
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 1:17705 HALE AVE
Mailing Address - Street 2:STE C3
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4340
Mailing Address - Country:US
Mailing Address - Phone:408-778-3135
Mailing Address - Fax:408-778-3008
Practice Address - Street 1:17705 HALE AVE
Practice Address - Street 2:STE C3
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4340
Practice Address - Country:US
Practice Address - Phone:408-778-3135
Practice Address - Fax:408-778-3008
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist