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General NPI Number Information
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NPI Number | 1639217813
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Entity Type | Individual
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Provider Name | WAYNE F LESUEUR D.M.D
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6200 S MCCLINTOCK DR STE 2
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City | TEMPE
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State | AZ
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Zip | 85283-3268
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Country | US
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Telephone | 480-838-3103
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Fax | 480-838-3458
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Provider Business Mailing Address
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Address Line | 6200 S MCCLINTOCK DR STE 2
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City | TEMPE
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State | AZ
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Zip | 85283-3268
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Country | US
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Telephone | 480-838-3103
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Fax | 480-838-3458
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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 | 2047
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License Number State | AZ
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