Provider Demographics
NPI:1588874663
Name:LEGASPI-ODULIO, LEILA (DMD INC)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:LEGASPI-ODULIO
Suffix:
Gender:F
Credentials:DMD INC
Other - Prefix:DR
Other - First Name:LEILA
Other - Middle Name:
Other - Last Name:LEGASPI-ODULIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1124 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1301
Mailing Address - Country:US
Mailing Address - Phone:650-755-0550
Mailing Address - Fax:650-755-0660
Practice Address - Street 1:1124 MISSION RD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-1301
Practice Address - Country:US
Practice Address - Phone:650-755-0550
Practice Address - Fax:650-755-0660
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice