Provider Demographics
NPI:1962539478
Name:MAES, LEROY LES (DDS)
Entity type:Individual
Prefix:DR
First Name:LEROY
Middle Name:LES
Last Name:MAES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8300 FAIRMOUNT DR
Mailing Address - Street 2:UNIT G102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6527
Mailing Address - Country:US
Mailing Address - Phone:303-355-3812
Mailing Address - Fax:303-355-6465
Practice Address - Street 1:5801 W 44TH AVE
Practice Address - Street 2:D160
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7488
Practice Address - Country:US
Practice Address - Phone:303-433-1239
Practice Address - Fax:303-455-5317
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO83641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8364OtherCOLORADO LICENSE NUMBER
CO74589253Medicaid