Provider Demographics
NPI:1407083322
Name:LESH & COMPANY PLLC
Entity Type:Organization
Organization Name:LESH & COMPANY PLLC
Other - Org Name:SOUTHERN TRACE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONNIE
Authorized Official - Last Name:LESH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-751-5777
Mailing Address - Street 1:3495 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7184
Mailing Address - Country:US
Mailing Address - Phone:352-751-5777
Mailing Address - Fax:
Practice Address - Street 1:3495 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-7184
Practice Address - Country:US
Practice Address - Phone:352-751-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty