Provider Demographics
NPI:1013658590
Name:NELSON, LESLIE LYNN (RDH)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:LYNN
Last Name:NELSON
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 1:11933 W 56TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1411
Mailing Address - Country:US
Mailing Address - Phone:720-224-2667
Mailing Address - Fax:
Practice Address - Street 1:8850 W 38TH AVE STE D
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4245
Practice Address - Country:US
Practice Address - Phone:303-425-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.00002234124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist