Provider Demographics
NPI:1255716700
Name:LESLIE B ANTHONY, DMD PC
Entity type:Organization
Organization Name:LESLIE B ANTHONY, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:406-752-8161
Mailing Address - Street 1:75 CLAREMONT ST STE G
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3500
Mailing Address - Country:US
Mailing Address - Phone:406-752-8161
Mailing Address - Fax:406-752-8090
Practice Address - Street 1:75 CLAREMONT ST STE G
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3500
Practice Address - Country:US
Practice Address - Phone:406-752-8161
Practice Address - Fax:406-752-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1866332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment