Provider Demographics
NPI:1295396299
Name:LESLIE J. ZIDE, DMD, INC.
Entity Type:Organization
Organization Name:LESLIE J. ZIDE, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:ZIDE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-297-2379
Mailing Address - Street 1:1795 MAIN STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103
Mailing Address - Country:US
Mailing Address - Phone:413-297-2379
Mailing Address - Fax:
Practice Address - Street 1:1795 MAIN STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103
Practice Address - Country:US
Practice Address - Phone:413-297-2379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty