Provider Demographics
NPI:1730207309
Name:SAMUELS, LESLEY J (DDS)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:J
Last Name:SAMUELS
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 1:905 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3339
Mailing Address - Country:US
Mailing Address - Phone:650-327-2310
Mailing Address - Fax:650-327-3307
Practice Address - Street 1:905 MIDDLEFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3339
Practice Address - Country:US
Practice Address - Phone:650-327-2310
Practice Address - Fax:650-327-3307
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2706401Medicare UPIN