Provider Demographics
NPI:1063583896
Name:LEIFESTE, NINA P SCALES (DDS)
Entity type:Individual
Prefix:DR
First Name:NINA P
Middle Name:SCALES
Last Name:LEIFESTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630
Mailing Address - Country:US
Mailing Address - Phone:409-886-4550
Mailing Address - Fax:409-882-0145
Practice Address - Street 1:1509 BURTON
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630
Practice Address - Country:US
Practice Address - Phone:409-886-4550
Practice Address - Fax:409-882-0145
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice