MEDICARE: LESLIE DILLARD PLLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1376147025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE DILLARD PLLC

Provider Business Mailing Address
First Line	:	121 BELLE FOREST CIR STE 2
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2157
Country	:	US
Telephone Number	:	615-646-9992
Fax Number	:	615-523-1352

Provider Business Practice Location Address
First Line	:	121 BELLE FOREST CIR STE 2
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2157
Country	:	US
Telephone Number	:	615-646-9992
Fax Number	:	615-523-1352

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. LESLIE P DILLARD
Credential	:	DDS
Telephone Number	:	615-646-9992

Provider Enumeration Date	:	11/24/2020
Last Update Date	:	11/24/2020

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Directions to “LESLIE DILLARD PLLC ” Practice Location

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