MEDICARE: DR. LESLIE DENISE HOLMES-LEACH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7055	SC
2	1223G0001X	General Practice Dentistry	9427	TN
3	122300000X	Dentist	DS0000009427	TN

General Provider Information

NPI Number	:	1104100064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE DENISE HOLMES-LEACH DMD

Provider Business Mailing Address
First Line	:	PO BOX 599
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-0599
Country	:	US
Telephone Number	:	865-426-7421
Fax Number	:	865-426-7422

Provider Business Practice Location Address
First Line	:	305 S MAIN ST
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-2206
Country	:	US
Telephone Number	:	865-426-7421
Fax Number	:	865-426-7422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	06/18/2020

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