Provider Demographics
NPI:1700040888
Name:TANAKA, LEILANI KIYOKO (DDS)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:KIYOKO
Last Name:TANAKA
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 1:1266 BONA TERRA LOOP NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1983
Mailing Address - Country:US
Mailing Address - Phone:510-847-6244
Mailing Address - Fax:
Practice Address - Street 1:6101 CANDELARIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2500
Practice Address - Country:US
Practice Address - Phone:505-883-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56715122300000X
TX25578122300000X
NM4196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist