Provider Demographics
NPI:1932694361
Name:CARPENTER, LESLIE GRAYCE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:GRAYCE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MURRAY HILL DR RM 140
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1153
Mailing Address - Country:US
Mailing Address - Phone:315-793-7620
Mailing Address - Fax:
Practice Address - Street 1:1 MURRAY HILL DR RM 140
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1153
Practice Address - Country:US
Practice Address - Phone:315-793-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027-029124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist