Provider Demographics
NPI:1225698178
Name:LESLIE, BRETT RYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:RYAN
Last Name:LESLIE
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 1:102 BROOKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-1702
Mailing Address - Country:US
Mailing Address - Phone:704-245-3024
Mailing Address - Fax:
Practice Address - Street 1:315 MOCKSVILLE AVE STE G
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3346
Practice Address - Country:US
Practice Address - Phone:704-245-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice