MEDICARE: DR. LESLIE ROBIN HALPERN DDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	7445	TN
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	10267883-9924	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V05611	OTHER	MA	BCBS MA
2	019997	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1023009669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ROBIN HALPERN DDS MD

Provider Business Mailing Address
First Line	:	1005 DB TODD JR BLVD
Second Line	:	MEHARRY MEDICAL COLLEGE
City	:	NASHVILLE
State	:	TN
Zip	:	37208-9142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 DB TODD JR BLVD
Second Line	:	MEHARRY MEDICAL COLLEGE
City	:	NASHVILLE
State	:	TN
Zip	:	37208-9142
Country	:	US
Telephone Number	:	615-327-6207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	11/02/2021

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