Provider Demographics
NPI:1932953924
Name:DIMAS, LEONA (RDH)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:
Last Name:DIMAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ROAD 2136
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-9334
Mailing Address - Country:US
Mailing Address - Phone:970-799-7795
Mailing Address - Fax:
Practice Address - Street 1:8422 W 78TH CIR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-4407
Practice Address - Country:US
Practice Address - Phone:970-799-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH002023607124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist