Provider Demographics
NPI:1073052833
Name:AFABLE, LESLIE (DDS)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:AFABLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 GIRARD AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3669
Mailing Address - Country:US
Mailing Address - Phone:305-613-3967
Mailing Address - Fax:
Practice Address - Street 1:300 E LONG LAKE RD STE 290
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2378
Practice Address - Country:US
Practice Address - Phone:248-203-2330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016008911223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice