Provider Demographics
NPI:1710983796
Name:BETZ, LESLIE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:BETZ
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 1:15022 MULBERRY DR
Mailing Address - Street 2:STE F
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-4436
Mailing Address - Country:US
Mailing Address - Phone:562-906-6400
Mailing Address - Fax:562-946-2370
Practice Address - Street 1:15022 MULBERRY DR
Practice Address - Street 2:STE F
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-4436
Practice Address - Country:US
Practice Address - Phone:562-906-6400
Practice Address - Fax:562-946-2370
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice