Provider Demographics
NPI:1679109987
Name:DUARTE, LLELY (DDS)
Entity type:Individual
Prefix:
First Name:LLELY
Middle Name:
Last Name:DUARTE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 W 5TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6426
Mailing Address - Country:US
Mailing Address - Phone:805-985-1800
Mailing Address - Fax:
Practice Address - Street 1:3611 W 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6426
Practice Address - Country:US
Practice Address - Phone:805-985-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171741223G0001X
CA1110351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice