Provider Demographics
NPI:1639223092
Name:LELAND, LINDSAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:
Last Name:LELAND
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 1:3960 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3502
Mailing Address - Country:US
Mailing Address - Phone:562-988-0148
Mailing Address - Fax:678-990-0359
Practice Address - Street 1:3960 ATLANTIC AVE STE 105-B
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3502
Practice Address - Country:US
Practice Address - Phone:562-988-0148
Practice Address - Fax:678-990-0359
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133331223G0001X
CA56897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice