Provider Demographics
NPI:1699829499
Name:CHMIELEWSKI, LEELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEELA
Middle Name:
Last Name:CHMIELEWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 S BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3983
Mailing Address - Country:US
Mailing Address - Phone:714-527-2982
Mailing Address - Fax:714-527-7394
Practice Address - Street 1:965 S BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3983
Practice Address - Country:US
Practice Address - Phone:714-527-2982
Practice Address - Fax:714-527-7394
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice