PEDIATRIC DENTISTRY OF LEBANON,PLLC (NPI# 1710434204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710434204 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTISTRY OF LEBANON,PLLC |
| Practice Address |
103 Physicians Way Ste 150 Lebanon TN 37090-4132 |
| Practice Telephone | 6155451812 |
| Mailing Telephone | 6155451812 |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |
| Authorized Official Name | DR. LESLIE SUZANNE WALLACE (DENTIST) |
| Authorized Official Telephone | 6155451812 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
8973 | TN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1514855 | 05 |
| Street Address |
103 PHYSICIANS WAY STE 150 |
| City | LEBANON |
| State | TN |
| Zip Code | 37090-4132 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629301833 | Leslie Suzanne Wallace | Dentist | 103 Physicians Way, Suite 150, Lebanon, TN 37090-4104 | 2009-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376926840 | Kathryn Mccloud | Physical Therapist | 163 Business Park Drive, Lebanon, TN 37090 | 2015-07-02 |
| 1811380926 | Samantha Smith | Nurse Practitioner | 101 Physicians Way Ste 111, Lebanon, TN 37090 | 2015-03-13 |
| 1760575831 | Ronald Scott Forczek | Respiratory Therapist, Certified | 8265 Trousdale Ferry Pike, Lebanon, TN 37090 | 2006-10-02 |
| 1649271206 | Roy C. Terry | Orthopaedic Surgery | 101 Physicians Way, Ste. 111, Lebanon, TN 37090 | 2005-08-04 |
| 1679570345 | Rhoda S Powers | Nurse Practitioner | 100 Physicians Way, Lebanon, TN 37090 | 2005-07-07 |
| 1285103689 | Jessica A Barron | Dermatology | 107 Glidepath Way, Lebanon, TN 37090 | 2018-11-15 |
| 1811109614 | Susan Anissa Hatcher | Occupational Therapy Assistant | 2215 Callis Rd, Lebanon, TN 37090 | 2007-05-04 |
| 1558386771 | Andre C Olivier | Internal Medicine | 100 Physicians Way, Suite 300, Lebanon, TN 37090 | 2006-07-12 |
| 1326030156 | Tennessee Orthopedics, P.C. | Orthopaedic Surgery | 101 Physicians Way, Ste. 111, Lebanon, TN 37090 | 2005-08-18 |
| 1154686673 | Stephanie Ruckman | Nurse Practitioner | 115 Moriah Dr, Lebanon, TN 37090-0731 | 2012-07-10 |
| Find all providers in zip 37090 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285279836 | Lebanon Pediatric Dentistry, LLC | Dentist | 920 S Hartmann Dr, Lebanon, TN 37090-4018 | 2019-11-07 |
| 1629301833 | Leslie Suzanne Wallace | Dentist | 103 Physicians Way, Suite 150, Lebanon, TN 37090-4104 | 2009-09-08 |
| 1801903067 | Richard Henry Gentzler IIi | Dentist | 106 Babb Dr, Lebanon, TN 37087-2506 | 2006-08-24 |
| 1922271642 | Richard H. Gentzler, IIi, Dds Pediatric Dentistry, Pllc | Dentist | 106 Babb Dr, Lebanon, TN 37087-2506 | 2008-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649879271 | Knoxville Pediatric Dentistry, Pllc | Dentist | 2944 Tazewell Pike Ste 1, Knoxville, TN 37918-1990 | 2020-10-24 |
| 1649886961 | Happy Teeth Pediatric Dentistry | Dentist | 129 Commons Dr, Martin, TN 38237-3882 | 2020-09-22 |
| 1144844879 | Dandridge Pediatric Dentistry | Dentist | 117 E Price Rd, Dandridge, TN 37725-4513 | 2020-05-28 |
| 1831711415 | Nashville Pediatric Dentistry | Dentist | 130 Seaboard Ln Ste A1, Franklin, TN 37067-8221 | 2020-05-18 |
| 1326685132 | East Nashville Pediatric Dentistry, Pllc | Dentist | 1077 E Trinity Ln Ste 104, Nashville, TN 37216-3067 | 2019-11-30 |
| 1225686157 | Brentwood Pediatric Dentistry Maryland Farms, Pllc | Dentist | 5109 Peter Taylor Park Dr Ste 100, Brentwood, TN 37027-7672 | 2019-09-04 |
| 1265087969 | Adventure Pediatric Dentistry, Pllc | Dentist | 6413 Lee Hwy Ste 119, Chattanooga, TN 37421-4861 | 2019-08-08 |
| 1942868336 | Juhn and Stark LLC | Dentist | 2333 Knob Creek Rd Ste 12, Johnson City, TN 37604-2007 | 2019-05-31 |
| 1093286304 | Wright Pediatric Dentistry | Dentist | 8202 Apison Pike, Ooltewah, TN 37363 | 2018-12-13 |
| 1013409887 | Springfield Pediatric Dentistry | Dentist | 3130 Tom Austin Hwy Ste B, Springfield, TN 37172 | 2018-06-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.