Provider Demographics
NPI:1316958234
Name:LESLIE, HERBERT BARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:BARRY
Last Name:LESLIE
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 1:700 SW BROAD ST
Mailing Address - Street 2:PO BOX 630
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5927
Mailing Address - Country:US
Mailing Address - Phone:910-692-7761
Mailing Address - Fax:910-692-7471
Practice Address - Street 1:700 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5927
Practice Address - Country:US
Practice Address - Phone:910-692-7761
Practice Address - Fax:910-692-7471
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC95227OtherBLUE CROSS
NC8995227Medicaid