Provider Demographics
NPI:1659478774
Name:MOORMAN, DIANA LESKO (DDS)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LESKO
Last Name:MOORMAN
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 1:451 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-1825
Mailing Address - Country:US
Mailing Address - Phone:317-736-8150
Mailing Address - Fax:
Practice Address - Street 1:549 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:NEW WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1365
Practice Address - Country:US
Practice Address - Phone:317-535-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN76391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice