Provider Demographics
NPI:1013058999
Name:OLTON, LESLIE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ANN
Last Name:OLTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 PAWTUCKET AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1716
Mailing Address - Country:US
Mailing Address - Phone:401-431-1224
Mailing Address - Fax:401-431-1224
Practice Address - Street 1:2224 PAWTUCKET AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1716
Practice Address - Country:US
Practice Address - Phone:401-431-1224
Practice Address - Fax:401-431-1224
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN26341223G0001X
CA412941223G0001X
NY0474171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice