Individual
LESLIE SUZANNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
103 PHYSICIANS WAY, SUITE 150, LEBANON, TN 37090-4104
(859) 948-0386
Mailing address
179 COBBLER CIR, HENDERSONVILLE, TN 37075-3963
(859) 948-0386
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8973
TN
Other
Enumeration date
09/08/2009
Last updated
01/08/2014
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