Healthcare Provider Details

I. General information

NPI: 1073533808
Provider Name (Legal Business Name): LESLEY T. BARATZ D.M.D, F.A.G.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 STANLEY DOLLAR DR APT 2
WALNUT CREEK CA
94595-2938
US

IV. Provider business mailing address

1137 STANLEY DOLLAR DR APT 2
WALNUT CREEK CA
94595-2938
US

V. Phone/Fax

Practice location:
  • Phone: 609-634-6599
  • Fax:
Mailing address:
  • Phone: 609-634-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS023024L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: