MEDICARE: LESLIE S BRIGHT DDS PA

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	6011	NC

General Provider Information

NPI Number	:	1093999682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE S BRIGHT DDS PA

Provider Business Mailing Address
First Line	:	5621 RAMSEY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-1423
Country	:	US
Telephone Number	:	910-488-3259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5621 RAMSEY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311-1423
Country	:	US
Telephone Number	:	910-488-3259
Fax Number	:	910-488-4637

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LESLIE SAMUEL BRIGHT JR.
Credential	:	DDS
Telephone Number	:	910-488-3259

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	04/29/2009

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