Provider Demographics
NPI:1336279447
Name:TARAZANO, LESLIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:TARAZANO
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 1:103 WYNDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9546
Mailing Address - Country:US
Mailing Address - Phone:570-563-1999
Mailing Address - Fax:
Practice Address - Street 1:320 W DRINKER ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1918
Practice Address - Country:US
Practice Address - Phone:570-344-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028520L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist