Healthcare Provider Details

I. General information

NPI: 1053246827
Provider Name (Legal Business Name): ISAIAS LEON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EXETER RD
JACKSON TN
38305-1829
US

IV. Provider business mailing address

24 WHEATSTONE DR
JACKSON TN
38301-3451
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-3000
  • Fax:
Mailing address:
  • Phone: 731-394-7095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13204
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: