Provider Demographics
NPI:1679703375
Name:TABESH, LEYLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEYLA
Middle Name:
Last Name:TABESH
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 1:4288 DUBLIN BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3178
Mailing Address - Country:US
Mailing Address - Phone:925-829-9884
Mailing Address - Fax:
Practice Address - Street 1:4288 DUBLIN BLVD STE 209
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3178
Practice Address - Country:US
Practice Address - Phone:258-299-8849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642401223G0001X
MND12730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist