Provider Demographics
NPI:1104100064
Name:HOLMES-LEACH, LESLIE DENISE (DMD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:DENISE
Last Name:HOLMES-LEACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:ROCKY TOP
Mailing Address - State:TN
Mailing Address - Zip Code:37769-0599
Mailing Address - Country:US
Mailing Address - Phone:865-426-7421
Mailing Address - Fax:865-426-7422
Practice Address - Street 1:305 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY TOP
Practice Address - State:TN
Practice Address - Zip Code:37769-2206
Practice Address - Country:US
Practice Address - Phone:865-426-7421
Practice Address - Fax:865-426-7422
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7055122300000X
TN94271223G0001X
TNDS0000009427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice