Healthcare Provider Details

I. General information

NPI: 1063613370
Provider Name (Legal Business Name): LESLIE HOLLEVOET DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S 12TH ST SUITE 1
BISMARCK ND
58504-6626
US

IV. Provider business mailing address

1223 S 12TH ST SUITE 1
BISMARCK ND
58504-6626
US

V. Phone/Fax

Practice location:
  • Phone: 701-221-0518
  • Fax:
Mailing address:
  • Phone: 701-221-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2073
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: