Provider Demographics
NPI:1437594876
Name:PHILIP, LESLIE T (DDS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:T
Last Name:PHILIP
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:N80W17707 CUSTER LN
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3630
Mailing Address - Country:US
Mailing Address - Phone:262-255-2727
Mailing Address - Fax:
Practice Address - Street 1:N80W17707 CUSTER LN
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3630
Practice Address - Country:US
Practice Address - Phone:262-255-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI69781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice