Provider Demographics
NPI:1710089537
Name:LESLIE, TIMOTHY NEAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:NEAL
Last Name:LESLIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TIM
Other - Middle Name:N
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3819 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1911
Mailing Address - Country:US
Mailing Address - Phone:806-794-1933
Mailing Address - Fax:
Practice Address - Street 1:3819 84TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1911
Practice Address - Country:US
Practice Address - Phone:806-794-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice