Provider Demographics
NPI:1548954100
Name:DE LEON, RIAN OLIVER DUQUE (DMD)
Entity type:Individual
Prefix:DR
First Name:RIAN OLIVER
Middle Name:DUQUE
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 1:575 W PECOS RD APT 2153
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7423
Mailing Address - Country:US
Mailing Address - Phone:949-735-1796
Mailing Address - Fax:
Practice Address - Street 1:5095 S GILBERT RD STE 7
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5711
Practice Address - Country:US
Practice Address - Phone:480-887-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0117901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice