Provider Demographics
NPI:1699853721
Name:SULTAN, LESLIE HARRIS (DDS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:HARRIS
Last Name:SULTAN
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 1:5400 N FEDERAL HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-771-8772
Mailing Address - Fax:954-771-8072
Practice Address - Street 1:5400 N FEDERAL HWY
Practice Address - Street 2:STE 102
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-771-8772
Practice Address - Fax:954-771-8072
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10648204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63434Medicare ID - Type Unspecified
T9628Medicare UPIN