Provider Demographics
NPI:1154306934
Name:ZIDE, LESLIE (DMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:ZIDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 INVERNESS LN
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-2826
Mailing Address - Country:US
Mailing Address - Phone:413-567-0760
Mailing Address - Fax:
Practice Address - Street 1:1049 MAIN ST
Practice Address - Street 2:CARING HEALTH CENTER, INC
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2114
Practice Address - Country:US
Practice Address - Phone:413-739-1100
Practice Address - Fax:413-304-4670
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028120Medicaid
MA110028120Medicaid
MA221829Medicare Oscar/Certification