Healthcare Provider Details

I. General information

NPI: 1699853721
Provider Name (Legal Business Name): LESLIE HARRIS SULTAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 N FEDERAL HWY STE 102
FT LAUDERDALE FL
33308
US

IV. Provider business mailing address

5400 N FEDERAL HWY STE 102
FT LAUDERDALE FL
33308
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8772
  • Fax: 954-771-8072
Mailing address:
  • Phone: 954-771-8772
  • Fax: 954-771-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN10648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: