Provider Demographics
NPI:1316343346
Name:DELEON DENTAL OFFICE
Entity type:Organization
Organization Name:DELEON DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:347-443-5633
Mailing Address - Street 1:60 E CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4404
Mailing Address - Country:US
Mailing Address - Phone:516-561-9459
Mailing Address - Fax:
Practice Address - Street 1:155 E MERRICK RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5925
Practice Address - Country:US
Practice Address - Phone:516-341-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty