MEDICARE: DR. CARLTON TAYLOR LEDING DDS

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	10537	TN

General Provider Information

NPI Number	:	1841728235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLTON TAYLOR LEDING DDS

Provider Business Mailing Address
First Line	:	1509 RIVERSIDE DR
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-2738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2153 GALLATIN PIKE N
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-2003
Country	:	US
Telephone Number	:	615-953-8946
Fax Number	:

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

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	05/30/2017

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