Provider Demographics
NPI:1669096160
Name:LEORA H SHEILY DDS PC
Entity type:Organization
Organization Name:LEORA H SHEILY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEORA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHEILY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-709-6695
Mailing Address - Street 1:1975 MANDEVILLE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2224
Mailing Address - Country:US
Mailing Address - Phone:310-709-6695
Mailing Address - Fax:
Practice Address - Street 1:4852 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-3736
Practice Address - Country:US
Practice Address - Phone:323-665-8168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty