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General NPI Number Information
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NPI Number | 1235697939
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Entity Type | Organization
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Legal Business Name | LESLIE I. DAVIS, BDS, DDS, PC
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 13802 W CAMINO DEL SOL STE 103
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4486
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Country | US
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Telephone | 623-584-0664
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Fax | 623-584-1728
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Provider Business Mailing Address
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Address Line | 13802 W CAMINO DEL SOL STE 103
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4486
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Country | US
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Telephone | 623-584-0664
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Fax | 623-584-1728
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Authorized Official
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Title or Position | OWNER
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Name | DR. LESLIE DAVIS
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Credential | BDS, DDS
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Telephone | 623-584-0664
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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 |
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License Number State |
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