Healthcare Provider Details

I. General information

NPI: 1881794550
Provider Name (Legal Business Name): LESLIE J. PARIS, D.D.S.,M.S.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 BOARDWALK DR UNIT 100
FORT COLLINS CO
80525-5937
US

IV. Provider business mailing address

4033 BOARDWALK DR UNIT 100
FORT COLLINS CO
80525-5937
US

V. Phone/Fax

Practice location:
  • Phone: 970-207-4061
  • Fax:
Mailing address:
  • Phone: 970-207-4061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6999
License Number StateCO

VIII. Authorized Official

Name: DR. LESLIE JANE PARIS
Title or Position: OWNER
Credential: D.D.S., M.S.D.
Phone: 970-207-4061