Healthcare Provider Details

I. General information

NPI: 1306047972
Provider Name (Legal Business Name): LESLIE ANNE CARTY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2076 HIGHWAY 51 NE
WESSON MS
39191-6859
US

IV. Provider business mailing address

PO BOX 69 2076 HWY. 51 NORTH
WESSON MS
39191-0069
US

V. Phone/Fax

Practice location:
  • Phone: 601-643-0026
  • Fax: 601-643-0530
Mailing address:
  • Phone: 601-643-0026
  • Fax: 601-643-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3123-00
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: