Provider Demographics
NPI:1326345539
Name:LESLIE H SULTAN DDS PA
Entity Type:Organization
Organization Name:LESLIE H SULTAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-771-8772
Mailing Address - Street 1:5400 N FEDERAL HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3201
Mailing Address - Country:US
Mailing Address - Phone:954-771-8772
Mailing Address - Fax:
Practice Address - Street 1:5400 N FEDERAL HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3201
Practice Address - Country:US
Practice Address - Phone:954-771-8772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty