MEDICARE: LESLIE WOODRUM RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H05727	AZ

General Provider Information

NPI Number	:	1457280174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE WOODRUM RDH

Provider Business Mailing Address
First Line	:	348 W ANDREW POTTER ST
Second Line	:
City	:	CORONA DE TUCSON
State	:	AZ
Zip	:	85641-2146
Country	:	US
Telephone Number	:	520-979-6871
Fax Number	:

Provider Business Practice Location Address
First Line	:	4888 N STONE AVE UNIT 120
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-5749
Country	:	US
Telephone Number	:	520-670-3909
Fax Number	:	520-309-2560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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