Provider Demographics
NPI:1902396872
Name:FRELS, LESLIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:FRELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 KERH BLVD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1218
Mailing Address - Country:US
Mailing Address - Phone:361-578-0326
Mailing Address - Fax:
Practice Address - Street 1:203 KERH BLVD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1218
Practice Address - Country:US
Practice Address - Phone:361-578-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics