Healthcare Provider Details

I. General information

NPI: 1609190875
Provider Name (Legal Business Name): LESLEY O. STARNES DDS MS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 BARRANCA PKWY SUITE 200
IRVINE CA
92604-8645
US

IV. Provider business mailing address

4980 BARRANCA PKWY SUITE 200
IRVINE CA
92604-8645
US

V. Phone/Fax

Practice location:
  • Phone: 949-551-6913
  • Fax: 949-551-6998
Mailing address:
  • Phone: 949-551-6913
  • Fax: 949-551-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18022
License Number StateCA

VIII. Authorized Official

Name: DR. LESLEY O. STARNES
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 949-551-6913