Provider Demographics
NPI:1053355214
Name:DAVIS, LESLIE I (BDS, DDS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:I
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13802 W CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4486
Mailing Address - Country:US
Mailing Address - Phone:623-584-0664
Mailing Address - Fax:623-584-1728
Practice Address - Street 1:13802 W CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4486
Practice Address - Country:US
Practice Address - Phone:623-584-0664
Practice Address - Fax:623-584-1728
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics