Provider Demographics
NPI:1447636527
Name:FIERRO, LEONCIO NIKOLAY (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONCIO
Middle Name:NIKOLAY
Last Name:FIERRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33215 MISSION BLVD
Mailing Address - Street 2:APT. B-222
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1449
Mailing Address - Country:US
Mailing Address - Phone:510-228-8644
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSS AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3039
Practice Address - Country:US
Practice Address - Phone:408-317-0162
Practice Address - Fax:510-405-9303
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist