Provider Demographics
NPI:1528262144
Name:EVANS, LESLEA (DDS)
Entity type:Individual
Prefix:
First Name:LESLEA
Middle Name:
Last Name:EVANS
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 1:1350 S TRADE DAYS BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2821
Mailing Address - Country:US
Mailing Address - Phone:903-567-2666
Mailing Address - Fax:
Practice Address - Street 1:1350 S TRADE DAYS BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2821
Practice Address - Country:US
Practice Address - Phone:903-567-2666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice