Provider Demographics
NPI:1902018278
Name:MIDLA, LESLIE PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:PAUL
Last Name:MIDLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 MAIN STREET
Mailing Address - Street 2:P.O. BOX 39
Mailing Address - City:BEALLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15313
Mailing Address - Country:US
Mailing Address - Phone:724-632-3350
Mailing Address - Fax:724-632-3360
Practice Address - Street 1:2842 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BEALLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15313
Practice Address - Country:US
Practice Address - Phone:724-632-3350
Practice Address - Fax:724-632-3360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-17664-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1147108184 Y JOtherADA NUMBER