Provider Demographics
NPI:1366494726
Name:GILBERT, LESLEY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:K
Last Name:GILBERT
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 1:104 KING JOHN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7302
Mailing Address - Country:US
Mailing Address - Phone:317-783-3685
Mailing Address - Fax:
Practice Address - Street 1:1852 FIELDS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-4005
Practice Address - Country:US
Practice Address - Phone:317-462-7223
Practice Address - Fax:317-467-8744
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice