Provider Demographics
NPI:1073533808
Name:BARATZ, LESLEY T (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:T
Last Name:BARATZ
Suffix:
Gender:F
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 STANLEY DOLLAR DR
Mailing Address - Street 2:APT 2
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2938
Mailing Address - Country:US
Mailing Address - Phone:609-634-6599
Mailing Address - Fax:
Practice Address - Street 1:1137 STANLEY DOLLAR DR
Practice Address - Street 2:APT 2
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-2938
Practice Address - Country:US
Practice Address - Phone:609-634-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023024L1223G0001X
CA51752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice