Provider Demographics
NPI:1124272406
Name:IMPERIAL, LEONORA (DDS)
Entity type:Individual
Prefix:
First Name:LEONORA
Middle Name:
Last Name:IMPERIAL
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 1:2150 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2003
Mailing Address - Country:US
Mailing Address - Phone:209-668-9442
Mailing Address - Fax:209-668-2781
Practice Address - Street 1:2150 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2003
Practice Address - Country:US
Practice Address - Phone:209-668-9442
Practice Address - Fax:209-668-2781
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice