Provider Demographics
NPI:1639338106
Name:MOONNUMAKAL, LEENA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEENA
Middle Name:M
Last Name:MOONNUMAKAL
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 1:5362 MCCULLOCH CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-6619
Mailing Address - Country:US
Mailing Address - Phone:714-595-3558
Mailing Address - Fax:
Practice Address - Street 1:4001 GARTH RD STE 104
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3100
Practice Address - Country:US
Practice Address - Phone:281-427-4736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00237841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry