| Pediatric Dentistry Of Lebanon,pllc | |
|
103 Physicians Way Ste 150 Lebanon TN 37090-4132 | |
| (615) 545-1812 | |
| Not Available |
| Full Name | Pediatric Dentistry Of Lebanon,pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 103 Physicians Way, Lebanon, Tennessee |
| Authorized Official Name and Position | Leslie Suzanne Wallace (DENTIST) |
| Authorized Official Contact | 6155451812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Dentistry Of Lebanon,pllc 103 Physicians Way Ste 150 Lebanon TN 37090-4132 Ph: (615) 545-1812 | Pediatric Dentistry Of Lebanon,pllc 103 Physicians Way Ste 150 Lebanon TN 37090-4132 Ph: (615) 545-1812 |
| NPI Number | 1710434204 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 09/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710434204 | NPI | - | NPPES |
| 1514855 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 8973 (Tennessee) | Primary |
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