Provider Demographics
NPI:1194334136
Name:ROBLES-LEYZAOLA, NEREA
Entity type:Individual
Prefix:
First Name:NEREA
Middle Name:
Last Name:ROBLES-LEYZAOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 E OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-1209
Mailing Address - Country:US
Mailing Address - Phone:614-639-1534
Mailing Address - Fax:
Practice Address - Street 1:154 E OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1209
Practice Address - Country:US
Practice Address - Phone:614-639-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0042891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics