Provider Demographics
NPI:1689639932
Name:DE LEON-TELLADO, NORMA IRIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:IRIS
Last Name:DE LEON-TELLADO
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:RR 36 BOX 8233
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9562
Mailing Address - Country:US
Mailing Address - Phone:787-717-3435
Mailing Address - Fax:
Practice Address - Street 1:255 CALLE ELEONOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2806
Practice Address - Country:US
Practice Address - Phone:787-763-9190
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR42518OtherNUM. PROVEEDOR TRIPLE S
PRD000210OtherNUM. PROVEEDOR MENONITA
PRP-890OtherNUM. PROVEEDOR IMC
PR739 0060OtherNUM. PROVEEDOR HUMANA