Provider Demographics
NPI:1083628135
Name:BROOKS, LESLIE GRAFF (DDS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:GRAFF
Last Name:BROOKS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E 100 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1903
Mailing Address - Country:US
Mailing Address - Phone:801-768-9471
Mailing Address - Fax:801-768-1287
Practice Address - Street 1:325 E 100 N
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1903
Practice Address - Country:US
Practice Address - Phone:801-768-9471
Practice Address - Fax:801-768-1287
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2646331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice