Provider Demographics
NPI:1497829816
Name:THOMAS, LESLY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLY
Middle Name:G
Last Name:THOMAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:SAN BERNADINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407
Mailing Address - Country:US
Mailing Address - Phone:909-887-1533
Mailing Address - Fax:909-887-6220
Practice Address - Street 1:4434 UNIVERSITY PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:SAN BERNADINO
Practice Address - State:CA
Practice Address - Zip Code:92407
Practice Address - Country:US
Practice Address - Phone:909-887-1533
Practice Address - Fax:909-887-6220
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA420101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice