Provider Demographics
NPI:1063769156
Name:SELDIN, LESLIE WILFRED (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:WILFRED
Last Name:SELDIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1503
Mailing Address - Country:US
Mailing Address - Phone:203-775-1377
Mailing Address - Fax:203-775-1377
Practice Address - Street 1:918 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1144
Practice Address - Country:US
Practice Address - Phone:917-834-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0266201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice