Provider Demographics
NPI:1598872236
Name:WEBB, LESLIE SOUTHGATE JR (DDS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SOUTHGATE
Last Name:WEBB
Suffix:JR
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 1:6800 PATTERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3626
Mailing Address - Country:US
Mailing Address - Phone:804-282-9781
Mailing Address - Fax:804-282-3647
Practice Address - Street 1:6800 PATTERSON AVENUE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3626
Practice Address - Country:US
Practice Address - Phone:804-282-9781
Practice Address - Fax:804-282-3647
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010038001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice