Provider Demographics
NPI:1669744280
Name:PENLEY, LESLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:
Last Name:PENLEY
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:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93921-0959
Mailing Address - Country:US
Mailing Address - Phone:831-402-5810
Mailing Address - Fax:
Practice Address - Street 1:3154 DEFOREST RD. SUITEA
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933
Practice Address - Country:US
Practice Address - Phone:831-384-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist