Provider Demographics
NPI:1861568487
Name:STILLMAN, LESLIE ERWIN (DDS)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:ERWIN
Last Name:STILLMAN
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 1:15127 JOG ROAD SUITE 104
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:561-498-0393
Mailing Address - Fax:561-598-0358
Practice Address - Street 1:15127 JOG ROAD SUITE 104
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-498-0393
Practice Address - Fax:561-598-0358
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL80721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice