=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326345539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LESLIE H SULTAN DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2011
-----------------------------------------------------
Last Update Date | 02/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5400 N FEDERAL HWY SUITE 102
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-771-8772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 N FEDERAL HWY SUITE 102
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33308-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-771-8772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LESLIE H SULTAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 954-771-8772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------