Provider Demographics
NPI:1366928285
Name:MANSHADI, LEILA NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:LEILA
Middle Name:NICOLE
Last Name:MANSHADI
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 1:18752 VIA SAN MARCO
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-3436
Mailing Address - Country:US
Mailing Address - Phone:949-293-5234
Mailing Address - Fax:
Practice Address - Street 1:2700 E WORKMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-6626
Practice Address - Country:US
Practice Address - Phone:626-634-3393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist