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 1:250 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3120
Mailing Address - Country:US
Mailing Address - Phone:617-228-1140
Mailing Address - Fax:
Practice Address - Street 1:31 PARK DR
Practice Address - Street 2:APT 9
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4916
Practice Address - Country:US
Practice Address - Phone:413-835-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA98131223G0001X
MADN1857105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice