MEDICARE: DR. LESLIE H TRIPPE D.D.S.

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	1223G0001X	General Practice Dentistry	20252	TX

General Provider Information

NPI Number	:	1053336842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE H TRIPPE D.D.S.

Provider Business Mailing Address
First Line	:	581 PAN AMERICAN DR
Second Line	:	SUITE 6
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-1960
Country	:	US
Telephone Number	:	254-699-3225
Fax Number	:	254-699-4647

Provider Business Practice Location Address
First Line	:	3650 CHAMBERS PASS, BLDG 3610
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234
Country	:	US
Telephone Number	:	919-339-9920
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/09/2022

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