MEDICARE: LESLIE FLAHAVEN DMD

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		NJ

General Provider Information

NPI Number	:	1669503819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE FLAHAVEN DMD

Provider Business Mailing Address
First Line	:	1500 S LINCOLN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08361-6610
Country	:	US
Telephone Number	:	856-691-2553
Fax Number	:	856-691-3370

Provider Business Practice Location Address
First Line	:	1500 S LINCOLN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08361-6610
Country	:	US
Telephone Number	:	856-691-2553
Fax Number	:	856-691-3370

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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