Provider Demographics
NPI:1902179963
Name:PARIS, LESLIE JANE (DDS,MSD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:JANE
Last Name:PARIS
Suffix:
Gender:F
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 BOARDWALK DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5937
Mailing Address - Country:US
Mailing Address - Phone:970-207-4061
Mailing Address - Fax:970-207-0051
Practice Address - Street 1:4033 BOARDWALK DR UNIT 100
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5937
Practice Address - Country:US
Practice Address - Phone:970-207-4061
Practice Address - Fax:970-207-0051
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69991223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics