Provider Demographics
NPI:1639217813
Name:LESUEUR, WAYNE F (DMD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:F
Last Name:LESUEUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 S MCCLINTOCK DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3268
Mailing Address - Country:US
Mailing Address - Phone:480-838-3103
Mailing Address - Fax:480-838-3458
Practice Address - Street 1:6200 S MCCLINTOCK DR STE 2
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3268
Practice Address - Country:US
Practice Address - Phone:480-838-3103
Practice Address - Fax:480-838-3458
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice