Provider Demographics
NPI:1356499586
Name:TARSA, LEILA (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:
Last Name:TARSA
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 'A' AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3056
Mailing Address - Country:US
Mailing Address - Phone:503-636-3383
Mailing Address - Fax:503-635-8632
Practice Address - Street 1:320 'A' AVENUE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3056
Practice Address - Country:US
Practice Address - Phone:503-636-3383
Practice Address - Fax:503-635-8632
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR87431223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics