Provider Demographics
NPI:1487723201
Name:SPANGLER, LESLIE A (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-3507
Mailing Address - Country:US
Mailing Address - Phone:715-379-8235
Mailing Address - Fax:
Practice Address - Street 1:3110 CRAIG RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6186
Practice Address - Country:US
Practice Address - Phone:715-552-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN57281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33791400Medicaid