Provider Demographics
NPI:1639353162
Name:DE LEON, MARIA ROSARIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ROSARIO
Last Name:DE LEON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROSEMARIE
Other - Middle Name:
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:204 BELLEVUE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1893
Mailing Address - Country:US
Mailing Address - Phone:973-783-4400
Mailing Address - Fax:973-783-4447
Practice Address - Street 1:204 BELLEVUE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1893
Practice Address - Country:US
Practice Address - Phone:973-783-4400
Practice Address - Fax:973-783-4447
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI022062001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice