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General NPI Number Information
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NPI Number | 1306093877
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Entity Type | Individual
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Provider Name | LESLIE M DALLY DO
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Gender | Male
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 944 SEARCY WAY
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7168
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Country | US
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Telephone | 270-467-7180
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Fax | 270-904-2862
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Provider Business Mailing Address
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Address Line | 944 SEARCY WAY
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7168
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Country | US
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Telephone | 270-467-7180
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Fax | 270-904-2862
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 03348
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License Number State | KY
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