Provider Demographics
NPI:1720427321
Name:BELLO, LESLIE LANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LANG
Last Name:BELLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:A
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6224 PORTSMOUTH BLVD #100
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-1351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6224 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-1351
Practice Address - Country:US
Practice Address - Phone:757-488-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist