G. Pete Leseberg D.M.D.,P.a.

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

B-3163 Issued in ID

Legal business name

G. PETE LESEBERG D.M.D.,P.A.

Practice address

1550 N Crestmont Dr
Ste G
Meridian, ID 83642-2184

Phone

(208) 884-0100

Fax

(208) 884-4844

NPI assigned

Feb 1, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Kamie Lund

Title

Office Manager

Phone

(208) 884-0100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1264982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264982400000",
    "number": "1346572435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N CRESTMONT DR",
            "address_2": "STE G",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422184",
            "telephone_number": "208-884-0100",
            "fax_number": "208-884-4844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 N CRESTMONT DR",
            "address_2": "STE G",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836422184",
            "telephone_number": "208-884-0100",
            "fax_number": "208-884-4844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G. PETE LESEBERG D.M.D.,P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-01",
        "last_updated": "2010-02-01",
        "status": "A",
        "authorized_official_last_name": "LUND",
        "authorized_official_first_name": "KAMIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-884-0100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "ID",
            "license": "B-3163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery Clinic/Center in Meridian, ID
• Providers in Meridian, ID by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; 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.