Provider Demographics
NPI:1780694018
Name:OWYANG, LEROY FELIX (DDS)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:FELIX
Last Name:OWYANG
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 1:43195 MISSION BLVD STE B3
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5340
Mailing Address - Country:US
Mailing Address - Phone:510-651-0833
Mailing Address - Fax:
Practice Address - Street 1:43195 MISSION BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539
Practice Address - Country:US
Practice Address - Phone:510-651-0833
Practice Address - Fax:510-651-0845
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice