Provider Demographics
NPI:1235697939
Name:LESLIE I. DAVIS, BDS, DDS, PC
Entity Type:Organization
Organization Name:LESLIE I. DAVIS, BDS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DDS
Authorized Official - Phone:623-584-0664
Mailing Address - Street 1:13802 W CAMINO DEL SOL STE 103
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4486
Mailing Address - Country:US
Mailing Address - Phone:623-584-0664
Mailing Address - Fax:623-584-1728
Practice Address - Street 1:13802 W CAMINO DEL SOL STE 103
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4486
Practice Address - Country:US
Practice Address - Phone:623-584-0664
Practice Address - Fax:623-584-1728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty