Provider Demographics
NPI:1578952776
Name:LELA DEKANO, DDS
Entity Type:Organization
Organization Name:LELA DEKANO, DDS
Other - Org Name:LELA DEKANO, DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-275-1137
Mailing Address - Street 1:435 N BEDFORD DR STE 306
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4344
Mailing Address - Country:US
Mailing Address - Phone:310-275-1137
Mailing Address - Fax:310-274-9876
Practice Address - Street 1:435 N BEDFORD DR STE 306
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4344
Practice Address - Country:US
Practice Address - Phone:310-275-1137
Practice Address - Fax:310-274-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty