MEDICARE: LESLEA EVANS 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	1223G0001X	General Practice Dentistry	23183	TX

General Provider Information

NPI Number	:	1528262144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEA EVANS DDS

Provider Business Mailing Address
First Line	:	1350 S TRADE DAYS BLVD
Second Line	:
City	:	CANTON
State	:	TX
Zip	:	75103-2821
Country	:	US
Telephone Number	:	903-567-2666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 S TRADE DAYS BLVD
Second Line	:
City	:	CANTON
State	:	TX
Zip	:	75103-2821
Country	:	US
Telephone Number	:	903-567-2666
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	06/28/2012

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