Provider Demographics
NPI:1265952279
Name:HARGIS-FULLER, LESLIE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MARIE
Last Name:HARGIS-FULLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 E DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5819
Mailing Address - Country:US
Mailing Address - Phone:226-226-8069
Mailing Address - Fax:
Practice Address - Street 1:294 E DAVIS ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5819
Practice Address - Country:US
Practice Address - Phone:336-226-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice