Provider Demographics
NPI:1477991792
Name:NELLOR, LESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:NELLOR
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 1:18316 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9466
Mailing Address - Country:US
Mailing Address - Phone:913-633-4195
Mailing Address - Fax:
Practice Address - Street 1:831 VERMONT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2665
Practice Address - Country:US
Practice Address - Phone:785-843-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2013-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist