Provider Demographics
NPI:1528613981
Name:DE LEON, NOEL ED MONTEVERDE (DDS)
Entity type:Individual
Prefix:DR
First Name:NOEL ED
Middle Name:MONTEVERDE
Last Name:DE LEON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33853 CASSIO CIR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2019
Mailing Address - Country:US
Mailing Address - Phone:562-480-2599
Mailing Address - Fax:
Practice Address - Street 1:81 BIRCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1407
Practice Address - Country:US
Practice Address - Phone:650-365-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice