Provider Demographics
NPI:1679592562
Name:METZGER, LESLIE M (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:METZGER
Suffix:
Gender:F
Credentials:DDS,PC
Other - Prefix:MRS
Other - First Name:LESLIE
Other - Middle Name:METZGER
Other - Last Name:DEBRINCAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22067 YORK MILLS CIR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3870
Mailing Address - Country:US
Mailing Address - Phone:248-349-6716
Mailing Address - Fax:
Practice Address - Street 1:33730 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-4718
Practice Address - Country:US
Practice Address - Phone:248-476-3410
Practice Address - Fax:248-476-1370
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010147971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice