Provider Demographics
NPI:1053368852
Name:MILFRED, LESLIE R (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:MILFRED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SE 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-2229
Mailing Address - Country:US
Mailing Address - Phone:503-253-0526
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2234
Practice Address - Country:US
Practice Address - Phone:503-227-4410
Practice Address - Fax:503-227-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR5611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist