Provider Demographics
NPI:1265128128
Name:LESLIE YUAN GAZDECK DDS PLLC
Entity type:Organization
Organization Name:LESLIE YUAN GAZDECK DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:YUAN GAZDECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-757-4600
Mailing Address - Street 1:1008 BIG OAK CT STE D
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6566
Mailing Address - Country:US
Mailing Address - Phone:984-733-0292
Mailing Address - Fax:
Practice Address - Street 1:1008 BIG OAK CT
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6566
Practice Address - Country:US
Practice Address - Phone:984-733-0292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty