MEDICARE: LESLIE JANE PARIS D.D.S.,M.S.D.

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	1223P0300X	Periodontics	6999	CO

General Provider Information

NPI Number	:	1902179963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE JANE PARIS D.D.S.,M.S.D.

Provider Business Mailing Address
First Line	:	4033 BOARDWALK DR UNIT 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5937
Country	:	US
Telephone Number	:	970-207-4061
Fax Number	:	970-207-0051

Provider Business Practice Location Address
First Line	:	4033 BOARDWALK DR UNIT 100
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5937
Country	:	US
Telephone Number	:	970-207-4061
Fax Number	:	970-207-0051

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

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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