Healthcare Provider Details

I. General information

NPI: 1235227224
Provider Name (Legal Business Name): LESLIE LYNN WARREN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE L ALLEN DDS

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 HWY 51 BYPASS WEST
DYERSBURG TN
38024
US

IV. Provider business mailing address

2234 EASTWOOD DR
TRIMBLE TN
38259-3256
US

V. Phone/Fax

Practice location:
  • Phone: 731-286-1271
  • Fax: 731-286-0019
Mailing address:
  • Phone: 731-676-8251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7872
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7872
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: