Provider Demographics
NPI:1114004322
Name:TAUB, LESLIE NEIL (DDS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NEIL
Last Name:TAUB
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 1:45005 W PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1252
Mailing Address - Country:US
Mailing Address - Phone:248-669-1040
Mailing Address - Fax:248-669-2176
Practice Address - Street 1:45005 W PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1252
Practice Address - Country:US
Practice Address - Phone:248-669-1040
Practice Address - Fax:248-669-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010125621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice