Provider Demographics
NPI:1154365617
Name:WOODELL, LESLIE M (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:WOODELL
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 1:838 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2080
Mailing Address - Country:US
Mailing Address - Phone:734-459-2400
Mailing Address - Fax:734-459-9463
Practice Address - Street 1:838 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-2080
Practice Address - Country:US
Practice Address - Phone:734-459-2400
Practice Address - Fax:734-459-9463
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010157951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice