Provider Demographics
NPI:1912778960
Name:LEONI DENTAL CORPORATION
Entity Type:Organization
Organization Name:LEONI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-500-6197
Mailing Address - Street 1:1955 CHERRYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-7360
Mailing Address - Country:US
Mailing Address - Phone:760-500-6197
Mailing Address - Fax:
Practice Address - Street 1:31897 DEL OBISPO ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3207
Practice Address - Country:US
Practice Address - Phone:760-500-6197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty