Provider Demographics
NPI:1871695171
Name:CARPENTER, LESLIE M HORNING (DDS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M HORNING
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S OAK KNOLL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2912
Mailing Address - Country:US
Mailing Address - Phone:626-795-4369
Mailing Address - Fax:626-795-4357
Practice Address - Street 1:200 S OAK KNOLL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2912
Practice Address - Country:US
Practice Address - Phone:626-795-4369
Practice Address - Fax:626-795-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0369411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice