Healthcare Provider Details

I. General information

NPI: 1477264067
Provider Name (Legal Business Name): LESLIE MCCLANAHAN HUNT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 WALLACE RD STE 106
NASHVILLE TN
37211-4981
US

IV. Provider business mailing address

1025 EMILY DR
GOODLETTSVILLE TN
37072-3532
US

V. Phone/Fax

Practice location:
  • Phone: 615-915-6090
  • Fax:
Mailing address:
  • Phone: 615-714-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: