Provider Demographics
NPI:1669527743
Name:MANIAS, LEDA MILENA (DDS)
Entity type:Individual
Prefix:DR
First Name:LEDA
Middle Name:MILENA
Last Name:MANIAS
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 1:1160 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7341
Mailing Address - Country:US
Mailing Address - Phone:650-851-4223
Mailing Address - Fax:650-851-1209
Practice Address - Street 1:880 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2915
Practice Address - Country:US
Practice Address - Phone:650-328-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice