Healthcare Provider Details

I. General information

NPI: 1457280174
Provider Name (Legal Business Name): LESLIE WOODRUM RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 N STONE AVE UNIT 120
TUCSON AZ
85704-5749
US

IV. Provider business mailing address

348 W ANDREW POTTER ST
CORONA DE TUCSON AZ
85641-2146
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-3909
  • Fax: 520-309-2560
Mailing address:
  • Phone: 520-979-6871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH05727
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: