MEDICARE: DR. LESLIE P DILLARD DDS

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	1223G0001X	General Practice Dentistry	8006	TN

General Provider Information

NPI Number	:	1427047679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE P DILLARD DDS

Provider Business Mailing Address
First Line	:	121 BELLE FOREST CIR
Second Line	:	STE 2
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2157
Country	:	US
Telephone Number	:	615-646-9992
Fax Number	:	615-523-1352

Provider Business Practice Location Address
First Line	:	121 BELLE FOREST CIR
Second Line	:	STE 2
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2157
Country	:	US
Telephone Number	:	615-646-9992
Fax Number	:	615-523-1352

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/20/2019

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