Provider Demographics
NPI:1023107810
Name:PASCO, LESLIE
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:PASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 TOWNE CENTRE DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-5613
Mailing Address - Country:US
Mailing Address - Phone:724-719-2866
Mailing Address - Fax:724-719-2867
Practice Address - Street 1:215 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052
Practice Address - Country:US
Practice Address - Phone:716-652-7080
Practice Address - Fax:716-652-3465
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist