Provider Demographics
NPI:1235227224
Name:WARREN, LESLIE LYNN (DDS)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:LYNN
Last Name:WARREN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:L
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2234 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRIMBLE
Mailing Address - State:TN
Mailing Address - Zip Code:38259-3256
Mailing Address - Country:US
Mailing Address - Phone:731-676-8251
Mailing Address - Fax:
Practice Address - Street 1:95 HWY 51 BYPASS WEST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024
Practice Address - Country:US
Practice Address - Phone:731-286-1271
Practice Address - Fax:731-286-0019
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7872122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry