Provider Demographics
NPI:1639663958
Name:MACARIO, LEILA (DMD)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:MACARIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 W KELLY RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-3014
Mailing Address - Country:US
Mailing Address - Phone:954-599-9530
Mailing Address - Fax:
Practice Address - Street 1:791 W KELLY RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3014
Practice Address - Country:US
Practice Address - Phone:954-599-9530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN235261223G0001X
ND23681223G0001X
CODEN.002045751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice