Healthcare Provider Details

I. General information

NPI: 1821401712
Provider Name (Legal Business Name): LESLIE TREHERNE-FAYTON D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 CONLON WAY STE A
ELIZABETH CITY NC
27909-9607
US

IV. Provider business mailing address

3875 CONLON WAY STE A
ELIZABETH CITY NC
27909-9607
US

V. Phone/Fax

Practice location:
  • Phone: 252-679-3143
  • Fax: 252-679-3144
Mailing address:
  • Phone: 252-679-3143
  • Fax: 252-679-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: