MEDICARE: DR. LESLIE I RICHMOND DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401005711	VA

General Provider Information

NPI Number	:	1023072717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE I RICHMOND DDS

Provider Business Mailing Address
First Line	:	337 PROVIDENCE RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23325-4608
Country	:	US
Telephone Number	:	757-424-3708
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 DIAMOND SPRINGS RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-3645
Country	:	US
Telephone Number	:	757-460-1939
Fax Number	:	757-460-2861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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