Healthcare Provider Details

I. General information

NPI: 1720246648
Provider Name (Legal Business Name): LESLIE STONE STONE HIRSH D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE STONE HIRSH D.D.S.

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 LOCUST STREET SUITE 120
PHILADELPHIA PA
19102
US

IV. Provider business mailing address

1420 LOCUST STREET SUITE 120
PHILADELPHIA PA
19102
US

V. Phone/Fax

Practice location:
  • Phone: 215-732-9171
  • Fax: 215-545-0892
Mailing address:
  • Phone: 215-732-9171
  • Fax: 215-545-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS026147L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: