Provider Demographics
NPI:1861603318
Name:JUE, LESLIE (DDS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:JUE
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 1:95 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-546-1680
Mailing Address - Fax:707-546-1682
Practice Address - Street 1:95 MONTGOMERY AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-546-1680
Practice Address - Fax:707-546-1682
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35739122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist