Provider Demographics
NPI:1033463799
Name:LESH, MATTHEW ELDON (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ELDON
Last Name:LESH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-7736
Mailing Address - Country:US
Mailing Address - Phone:360-458-7645
Mailing Address - Fax:
Practice Address - Street 1:202 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-7736
Practice Address - Country:US
Practice Address - Phone:360-458-7645
Practice Address - Fax:360-458-2745
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD98101223G0001X
WADE603184721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice