Provider Demographics
NPI:1922196880
Name:STARNES, LESLEY OTIS (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:OTIS
Last Name:STARNES
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 E. CALIFORNIA ST.
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240
Mailing Address - Country:US
Mailing Address - Phone:940-665-9715
Mailing Address - Fax:940-665-9714
Practice Address - Street 1:1219 E. CALIFORNIA ST.
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240
Practice Address - Country:US
Practice Address - Phone:940-665-9715
Practice Address - Fax:940-665-9714
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180221223X0400X
TX177801223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2137952Medicaid