MEDICARE: LESLIE MCCLANAHAN HUNT RDH

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	124Q00000X	Dental Hygienist	6797	TN

General Provider Information

NPI Number	:	1477264067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE MCCLANAHAN HUNT RDH

Provider Business Mailing Address
First Line	:	1025 EMILY DR
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-3532
Country	:	US
Telephone Number	:	615-714-5956
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 WALLACE RD STE 106
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-4981
Country	:	US
Telephone Number	:	615-915-6090
Fax Number	:

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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