Provider Demographics
NPI:1134771975
Name:FREEMAN, LESLIE MILLS (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:MILLS
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 OAKLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-3442
Mailing Address - Country:US
Mailing Address - Phone:321-323-6173
Mailing Address - Fax:
Practice Address - Street 1:23678 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3336
Practice Address - Country:US
Practice Address - Phone:251-928-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006666-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice