Provider Demographics
NPI:1851644694
Name:LESLIE ROBERT FISH DDS PC
Entity Type:Organization
Organization Name:LESLIE ROBERT FISH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-726-6600
Mailing Address - Street 1:1200 W WARNER RD
Mailing Address - Street 2:SUITE, #3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2758
Mailing Address - Country:US
Mailing Address - Phone:480-726-6600
Mailing Address - Fax:480-726-6611
Practice Address - Street 1:1200 W WARNER RD
Practice Address - Street 2:SUITE, #3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2758
Practice Address - Country:US
Practice Address - Phone:480-726-6600
Practice Address - Fax:480-726-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2825204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty