Provider Demographics
NPI:1285678854
Name:GRANT, LESLIE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:GRANT
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 1:5800 LOCH RAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2438
Mailing Address - Country:US
Mailing Address - Phone:410-532-1024
Mailing Address - Fax:410-433-0186
Practice Address - Street 1:5800 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2438
Practice Address - Country:US
Practice Address - Phone:410-532-1024
Practice Address - Fax:410-433-0186
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD095031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice