Provider Demographics
NPI:1871063412
Name:LESH, DMD PLLC
Entity type:Organization
Organization Name:LESH, DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:LESH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-458-7645
Mailing Address - Street 1:202 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597
Mailing Address - Country:US
Mailing Address - Phone:360-458-7645
Mailing Address - Fax:
Practice Address - Street 1:202 1ST ST S
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597
Practice Address - Country:US
Practice Address - Phone:360-458-7645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental