Provider Demographics
NPI:1720232143
Name:DE LEON, JOSEPH LEMUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEMUEL
Last Name:DE LEON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:924-898-9421
Mailing Address - Fax:
Practice Address - Street 1:1869 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4625
Practice Address - Country:US
Practice Address - Phone:631-416-5480
Practice Address - Fax:631-994-2900
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857105122300000X
MA98131223G0001X
NY060985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06551766Medicaid