Healthcare Provider Details

I. General information

NPI: 1902179963
Provider Name (Legal Business Name): LESLIE JANE PARIS D.D.S.,M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
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: 970-207-0051
Mailing address:
  • Phone: 970-207-4061
  • Fax: 970-207-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: