Provider Demographics
NPI:1437387651
Name:MAYER, LESLIE SCRUGGS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:SCRUGGS
Last Name:MAYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:YVONNE
Other - Last Name:SCRUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:620 MEADOWBRIAR ST.
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573
Mailing Address - Country:US
Mailing Address - Phone:409-359-5253
Mailing Address - Fax:
Practice Address - Street 1:1201 21ST ST N
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590
Practice Address - Country:US
Practice Address - Phone:409-359-5253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24756122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist