Provider Demographics
NPI:1144719352
Name:WEIDERT, LESLEY LAMBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:LAMBERT
Last Name:WEIDERT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LESLEY
Other - Middle Name:ERIN
Other - Last Name:LAMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:149 YADKIN VALLEY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006
Mailing Address - Country:US
Mailing Address - Phone:336-998-1076
Mailing Address - Fax:
Practice Address - Street 1:149 YADKIN VALLEY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006
Practice Address - Country:US
Practice Address - Phone:336-998-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN49081223G0001X
NC136121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice