MEDICARE: W.G. LESLIE DDS, INC

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	3172	OK

General Provider Information

NPI Number	:	1427139369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W.G. LESLIE DDS, INC

Provider Business Mailing Address
First Line	:	2525 NW EXPRESSWAY ST
Second Line	:	SUITE 102
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7203
Country	:	US
Telephone Number	:	405-848-6671
Fax Number	:	405-848-6672

Provider Business Practice Location Address
First Line	:	2525 NW EXPRESSWAY ST
Second Line	:	SUITE 102
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7203
Country	:	US
Telephone Number	:	405-848-6671
Fax Number	:	405-848-6672

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIS G LESLIE
Credential	:	DDS
Telephone Number	:	405-848-6671

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/22/2020

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