Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 458428 | OK |
NPI | 1104084359 |
---|---|
Provider Name | Dennis Allan Leseberg |
First Address | Oklahoma City, OK 73118-6084 |
Second Address | Oklahoma City, OK 73118-6084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 23/05/2008 |