Provider Demographics
NPI:1407197254
Name:TIMMERMAN, LESLIE SUE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:SUE
Last Name:TIMMERMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 GULL RD
Mailing Address - Street 2:W1 G5
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1281
Mailing Address - Country:US
Mailing Address - Phone:269-373-5158
Mailing Address - Fax:
Practice Address - Street 1:3299 GULL RD
Practice Address - Street 2:W1 G5
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1281
Practice Address - Country:US
Practice Address - Phone:269-373-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902011323124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist