Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401006116 | VA |
NPI | 1124261334 |
---|---|
Provider Name | Dr. Lesley West |
First Address | Centreville, VA 20121-2344 |
Second Address | Centreville, VA 20121-2344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 17/04/2009 |