Provider Demographics
NPI:1740352889
Name:LEON, LILI A (DDS)
Entity type:Individual
Prefix:DR
First Name:LILI
Middle Name:A
Last Name:LEON
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 1:9832 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-5101
Mailing Address - Country:US
Mailing Address - Phone:410-371-4373
Mailing Address - Fax:
Practice Address - Street 1:11908 DARNESTOWN RD
Practice Address - Street 2:SUITE F
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2295
Practice Address - Country:US
Practice Address - Phone:301-527-4343
Practice Address - Fax:301-527-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD126821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics