Provider Demographics
NPI:1770588865
Name:TOURENO, LEO (DDS)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:TOURENO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 W IRVINGTON ROAD
Mailing Address - Street 2:STE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746
Mailing Address - Country:US
Mailing Address - Phone:520-889-1100
Mailing Address - Fax:520-889-0700
Practice Address - Street 1:5121 S CALLE SANTA CRUZ
Practice Address - Street 2:STE 105
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-3547
Practice Address - Country:US
Practice Address - Phone:520-889-1100
Practice Address - Fax:520-889-0700
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-08-23
Deactivation Date:2011-02-22
Deactivation Code:
Reactivation Date:2012-04-05
Provider Licenses
StateLicense IDTaxonomies
AZ59611223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062125Medicaid