Provider Demographics
NPI:1750400016
Name:LESLEY, STACY L (DDS)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:LESLEY
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 1:10030 EDISON SQUARE DR NW STE 200
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8309
Mailing Address - Country:US
Mailing Address - Phone:704-766-1488
Mailing Address - Fax:704-766-1496
Practice Address - Street 1:10030 EDISON SQUARE DR NW STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8309
Practice Address - Country:US
Practice Address - Phone:704-766-1488
Practice Address - Fax:704-766-1496
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC75681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice