Provider Demographics
NPI:1902338130
Name:LEONG, NARITA LIM (DDS)
Entity Type:Individual
Prefix:
First Name:NARITA
Middle Name:LIM
Last Name:LEONG
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 1:1430 TARA HILLS DR STE C
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2512
Mailing Address - Country:US
Mailing Address - Phone:510-724-8001
Mailing Address - Fax:
Practice Address - Street 1:1430 TARA HILLS DR STE C
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2512
Practice Address - Country:US
Practice Address - Phone:510-724-8001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1029061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program