Provider Demographics
NPI:1538224126
Name:LESLIE, DAVID H (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:LESLIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:H
Other - Last Name:LESLIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:6060 43RD AVE WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-795-8100
Mailing Address - Fax:941-795-4959
Practice Address - Street 1:6060 43RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-6620
Practice Address - Country:US
Practice Address - Phone:941-795-8100
Practice Address - Fax:941-795-4959
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN91341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice