Provider Demographics
NPI:1669658985
Name:BROWN, LESLIE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:S
Last Name:BROWN
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 1:6700 CROSSWINDS DR N
Mailing Address - Street 2:SUITE 200 B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8602
Mailing Address - Country:US
Mailing Address - Phone:727-384-9122
Mailing Address - Fax:727-384-9123
Practice Address - Street 1:6700 CROSSWINDS DR N
Practice Address - Street 2:SUITE 200 B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8602
Practice Address - Country:US
Practice Address - Phone:727-384-9122
Practice Address - Fax:727-384-9123
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL059621223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics