Provider Demographics
NPI:1679986301
Name:DARNELL, LESLIE (DMD, MSD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DARNELL
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 E SHEA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6411
Mailing Address - Country:US
Mailing Address - Phone:480-991-0090
Mailing Address - Fax:480-951-2278
Practice Address - Street 1:7425 E SHEA BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6411
Practice Address - Country:US
Practice Address - Phone:480-991-0090
Practice Address - Fax:480-951-2278
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0108731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics