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Organization
MARK CHEVY S LEDESMA DDS INC
Active
Organization
MARK CHEVY S LEDESMA DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK CHEVY S LEDESMA DDS (DENTIST PRESIDENT)
(626) 967-7727
Entity
Organization
Contact information
Practice address
319 N AZUSA AVE, W COVINA, CA 91791
(626) 967-7727
(626) 967-7887
Mailing address
319 N AZUSA AVE, W COVINA, CA 91791
(626) 967-7727
(626) 967-7887
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
44006
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9228801
DENTICAL
CA
Enumeration date
02/13/2007
Last updated
12/31/2014
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