Provider Demographics
NPI:1972979607
Name:LEON-GUERRERO, NICHOLAS EVERETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:EVERETT
Last Name:LEON-GUERRERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:LEON-GUERRERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4350 FAIRFAX DR STE 160
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1626
Mailing Address - Country:US
Mailing Address - Phone:703-940-3070
Mailing Address - Fax:
Practice Address - Street 1:4350 FAIRFAX DR STE 160
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1626
Practice Address - Country:US
Practice Address - Phone:703-940-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058018122300000X
VA04014164541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist