Provider Demographics
NPI:1598722811
Name:WACHTEL, LEON LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:LESLIE
Last Name:WACHTEL
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 1:222 S SUMMIT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303
Mailing Address - Country:US
Mailing Address - Phone:928-445-0582
Mailing Address - Fax:928-443-0974
Practice Address - Street 1:222 S SUMMIT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303
Practice Address - Country:US
Practice Address - Phone:928-445-0582
Practice Address - Fax:928-443-0974
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice