Provider Demographics
NPI:1124021118
Name:CHOW, LESLIE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:C
Last Name:CHOW
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 1:1250 HERCULES AVE
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3762
Mailing Address - Country:US
Mailing Address - Phone:510-727-5375
Mailing Address - Fax:
Practice Address - Street 1:2830 PINOLE VALLEY RD STE A
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1453
Practice Address - Country:US
Practice Address - Phone:510-758-6684
Practice Address - Fax:510-669-2083
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA396181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice