Provider Demographics
NPI:1962548313
Name:DENES, LESLIE IVAN (OD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:IVAN
Last Name:DENES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6609 WESTBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-661-2274
Mailing Address - Fax:
Practice Address - Street 1:6476 ORCHARD LK ROAD
Practice Address - Street 2:15631 GRAND RIVER DETROIT MI
Practice Address - City:W. BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-851-6300
Practice Address - Fax:248-538-1460
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901003050152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist