1205173457 NPI number — WILLIAM G. LESH DMD, PS

Table of content: (NPI 1205173457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205173457 NPI number — WILLIAM G. LESH DMD, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM G. LESH DMD, PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DREAM DENTISTRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205173457
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 14TH AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-200-4924
Provider Business Mailing Address Fax Number:
360-200-4923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-200-4924
Provider Business Practice Location Address Fax Number:
360-200-4923
Provider Enumeration Date:
01/08/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LESH
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
KALOB
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-200-4924

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00007934 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 60769596 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)