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General NPI Number Information
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NPI Number | 1194914374
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Entity Type | Individual
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Provider Name | LESLIE S NEVILLE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 311 S DIXIE ST
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City | HORSE CAVE
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State | KY
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Zip | 42749-1230
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Country | US
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Telephone | 270-786-2547
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Fax | 270-786-4576
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Provider Business Mailing Address
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Address Line | 311 S DIXIE ST P. O. BOX 324
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City | HORSE CAVE
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State | KY
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Zip | 42749-1230
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Country | US
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Telephone | 270-786-2547
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Fax | 270-786-4576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8533
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License Number State | KY
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