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General NPI Number Information
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NPI Number | 1033463799
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Entity Type | Individual
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Provider Name | MATTHEW ELDON LESH DMD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 202 1ST ST S
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City | YELM
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State | WA
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Zip | 98597-7736
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Country | US
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Telephone | 360-458-7645
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Fax | 360-458-2745
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Provider Business Mailing Address
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Address Line | 202 1ST ST S
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City | YELM
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State | WA
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Zip | 98597-7736
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Country | US
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Telephone | 360-458-7645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D9810
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60318472
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License Number State | WA
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