Provider Demographics
NPI:1992798342
Name:INONG, MAYWELL LYNN LEONES (DDS)
Entity type:Individual
Prefix:
First Name:MAYWELL LYNN
Middle Name:LEONES
Last Name:INONG
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 1:4568 FEATHER RIVER DR
Mailing Address - Street 2:SUITE E.
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6508
Mailing Address - Country:US
Mailing Address - Phone:209-477-9105
Mailing Address - Fax:209-477-1526
Practice Address - Street 1:4568 FEATHER RIVER DR
Practice Address - Street 2:SUITE E.
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-6508
Practice Address - Country:US
Practice Address - Phone:209-477-9105
Practice Address - Fax:209-477-1526
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-04-01
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CA46610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist