Provider Demographics
NPI:1225349400
Name:MAXWELL, LESLEY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:ANN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 SOUTH SHERIDAN
Mailing Address - Street 2:SUITE #8
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2765
Mailing Address - Country:US
Mailing Address - Phone:918-492-1917
Mailing Address - Fax:918-492-4538
Practice Address - Street 1:7104 S SHERIDAN RD
Practice Address - Street 2:SUITE #8
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2770
Practice Address - Country:US
Practice Address - Phone:918-492-1917
Practice Address - Fax:918-492-4538
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist