Organization
PORTOLA DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC ERNEST LEBLANC DDS (DENTIST)
(760) 346-1414
Entity
Organization
Contact information
Practice address
44853 PORTOLA AVENUE, STE B, PALM DESERT, CA 92260
(760) 346-1414
(760) 346-7335
Mailing address
44853 PORTOLA AVENUE, STE B, PALM DESERT, CA 92260
(760) 346-1414
(760) 346-7335
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
36169
CA
305R00000X
Preferred Provider Organization
Primary
51212
OK
Other
Enumeration date
11/18/2013
Last updated
11/18/2013
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