MEDICARE: AUBREY C LESH RDH

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	124Q00000X	Dental Hygienist	002023914	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043602782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY C LESH RDH

Provider Business Mailing Address
First Line	:	5910 STETSON HILLS BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3580
Country	:	US
Telephone Number	:	719-694-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	5910 STETSON HILLS BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3580
Country	:	US
Telephone Number	:	719-694-0400
Fax Number	:

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

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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