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General NPI Number Information
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NPI Number | 1154427029
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Entity Type | Individual
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Provider Name | LESLIE EDWARD BROLINE DDS MS
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3508 FAR WEST BLVD STE 330
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City | AUSTIN
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State | TX
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Zip | 78731-3041
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Country | US
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Telephone | 512-343-9488
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Fax | 512-343-1062
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Provider Business Mailing Address
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Address Line | 3508 FAR WEST BLVD STE 330
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City | AUSTIN
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State | TX
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Zip | 78731-3041
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Country | US
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Telephone | 512-343-9488
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Fax | 512-343-1062
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 9766
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License Number State | TX
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