Provider Demographics
NPI:1023072717
Name:RICHMOND, LESLIE I (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:I
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4608
Mailing Address - Country:US
Mailing Address - Phone:757-424-3708
Mailing Address - Fax:
Practice Address - Street 1:1300 DIAMOND SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-3645
Practice Address - Country:US
Practice Address - Phone:757-460-1939
Practice Address - Fax:757-460-2861
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist