Provider Demographics
NPI:1063513364
Name:DAVIS, LESLIE R (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7014 WOODED MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6411
Mailing Address - Country:US
Mailing Address - Phone:502-417-9454
Mailing Address - Fax:502-587-1737
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-587-8839
Practice Address - Fax:502-587-1737
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice