Healthcare Provider Details

I. General information

NPI: 1194914374
Provider Name (Legal Business Name): LESLIE S NEVILLE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S DIXIE ST
HORSE CAVE KY
42749-1230
US

IV. Provider business mailing address

311 S DIXIE ST P. O. BOX 324
HORSE CAVE KY
42749-1230
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-2547
  • Fax: 270-786-4576
Mailing address:
  • Phone: 270-786-2547
  • Fax: 270-786-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8533
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: