Provider Demographics
NPI:1295619443
Name:FICKLING, LESLIE MADISON (DMD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MADISON
Last Name:FICKLING
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5832 SUMMERALL VISTA CIR APT 4-117
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-5103
Mailing Address - Country:US
Mailing Address - Phone:706-306-9037
Mailing Address - Fax:
Practice Address - Street 1:10625 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7176
Practice Address - Country:US
Practice Address - Phone:813-549-0931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN30879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist