Provider Demographics
NPI:1326048109
Name:WEINHOLD, LEE LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:LESLIE
Last Name:WEINHOLD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1288
Mailing Address - Country:US
Mailing Address - Phone:507-533-7735
Mailing Address - Fax:597-533-8852
Practice Address - Street 1:100 2ND ST SE
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1288
Practice Address - Country:US
Practice Address - Phone:507-533-7735
Practice Address - Fax:597-533-8852
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist