Provider Demographics
NPI:1356754899
Name:GUARDIOLA, LEONEL (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONEL
Middle Name:
Last Name:GUARDIOLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LONNIE
Other - Middle Name:
Other - Last Name:GUARDIOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1125 W FM 544
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098
Mailing Address - Country:US
Mailing Address - Phone:972-442-3028
Mailing Address - Fax:972-442-3831
Practice Address - Street 1:822 STEGER TOWNE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5658
Practice Address - Country:US
Practice Address - Phone:972-771-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice