Provider Demographics
NPI:1427047679
Name:DILLARD, LESLIE P (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:P
Last Name:DILLARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BELLE FOREST CIR
Mailing Address - Street 2:STE 2
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2157
Mailing Address - Country:US
Mailing Address - Phone:615-646-9992
Mailing Address - Fax:615-523-1352
Practice Address - Street 1:121 BELLE FOREST CIR
Practice Address - Street 2:STE 2
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-2157
Practice Address - Country:US
Practice Address - Phone:615-646-9992
Practice Address - Fax:615-523-1352
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice