Provider Demographics
NPI:1952980674
Name:WOLFORD, LESLIE P (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:P
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7806
Mailing Address - Country:US
Mailing Address - Phone:681-753-8157
Mailing Address - Fax:
Practice Address - Street 1:1215 JOHNSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1389
Practice Address - Country:US
Practice Address - Phone:304-842-0590
Practice Address - Fax:304-842-0591
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0443621223E0200X
MD181451223E0200X
WV45571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics