| NPI | 1902160450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH M. LEONARD Dds 731-300-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN DS7790) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN DS3413) |
| 1223G0001X Dentist General Practice (Licence: TN DS8401) | |
| 1223G0001X Dentist General Practice (Licence: TN DS3682) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2018-08-07 |