Individual provider Active NPI

Dennis Allan Leseberg, DDS MS

  • Endodontics
  • Oklahoma City, OK
National Provider Identifier
1104084359
Registry record updated May 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
458428 Issued in OK
Practice address
1008 NW Grand Blvd
Suite a
Oklahoma City, OK 73118-6084
Phone
(405) 843-9330
Fax
(405) 848-4048
NPI assigned
May 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X 458428 OK Primary

Addresses

Primary practice location

1008 NW Grand Blvd
Suite a
Oklahoma City, OK 73118-6084

Mailing address

1008 NW Grand Blvd
Suite a
Oklahoma City, OK 73118-6084
Phone (405) 843-9330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
458428OKMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Oklahoma Endodontics Endodontics Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1104084359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1008 NW GRAND BLVD",
            "address_2": "SUITE A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731186084",
            "telephone_number": "405-843-9330",
            "fax_number": "405-848-4048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 NW GRAND BLVD",
            "address_2": "SUITE A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731186084",
            "telephone_number": "405-843-9330",
            "fax_number": "405-848-4048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESEBERG",
        "first_name": "DENNIS",
        "middle_name": "ALLAN",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "OK",
            "license": "458428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.