Provider Demographics
NPI:1720468929
Name:ESDL DE LEON DDS INC
Entity Type:Organization
Organization Name:ESDL DE LEON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-396-2703
Mailing Address - Street 1:1375 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2917
Mailing Address - Country:US
Mailing Address - Phone:510-582-8277
Mailing Address - Fax:510-582-0305
Practice Address - Street 1:1375 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2917
Practice Address - Country:US
Practice Address - Phone:510-582-8277
Practice Address - Fax:510-582-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty