MEDICARE: DR. WILLIAM KALOB LESH DDS

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	1223G0001X	General Practice Dentistry	DE60769596	WA

General Provider Information

NPI Number	:	1801316575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM KALOB LESH DDS

Provider Business Mailing Address
First Line	:	950 14TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2317
Country	:	US
Telephone Number	:	360-200-4924
Fax Number	:	360-200-4923

Provider Business Practice Location Address
First Line	:	950 14TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2317
Country	:	US
Telephone Number	:	360-200-4924
Fax Number	:	360-200-4923

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	07/21/2022

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