Provider Demographics
NPI:1427275189
Name:SERA, LEEANNE SETSUMI (DDS)
Entity type:Individual
Prefix:DR
First Name:LEEANNE
Middle Name:SETSUMI
Last Name:SERA
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 1:2585 HOMESTEAD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5375
Mailing Address - Country:US
Mailing Address - Phone:408-248-3110
Mailing Address - Fax:
Practice Address - Street 1:2585 HOMESTEAD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5375
Practice Address - Country:US
Practice Address - Phone:408-248-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice