Provider Demographics
NPI:1023009669
Name:HALPERN, LESLIE ROBIN (DDS MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ROBIN
Last Name:HALPERN
Suffix:
Gender:F
Credentials:DDS MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 DB TODD JR BLVD
Mailing Address - Street 2:MEHARRY MEDICAL COLLEGE
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-9142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 DB TODD JR BLVD
Practice Address - Street 2:MEHARRY MEDICAL COLLEGE
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-9142
Practice Address - Country:US
Practice Address - Phone:615-327-6207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7445204E00000X
UT10267883-99241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV05611OtherBCBS MA
MA019997OtherTUFTS HEALTH PLAN
G43770Medicare UPIN
MAX20077Medicare ID - Type Unspecified