Provider Demographics
NPI:1396883237
Name:ROISMAN, LEON D (DMD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:D
Last Name:ROISMAN
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 1:310 S LAKE AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3540
Mailing Address - Country:US
Mailing Address - Phone:626-795-6855
Mailing Address - Fax:626-432-4270
Practice Address - Street 1:310 S LAKE AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3540
Practice Address - Country:US
Practice Address - Phone:626-795-6855
Practice Address - Fax:626-432-4270
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19960122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD19960OtherDENTICAL