Provider Demographics
NPI:1801015813
Name:LEONG, DAVID J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LEONG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 MIWOK WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-2004
Mailing Address - Country:US
Mailing Address - Phone:925-672-7093
Mailing Address - Fax:
Practice Address - Street 1:2642B SOMERSVILLE RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4428
Practice Address - Country:US
Practice Address - Phone:925-778-4600
Practice Address - Fax:925-777-2061
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice