Provider Demographics
NPI:1609255587
Name:LEISER, CLAIRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:
Last Name:LEISER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:12009 BROADWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4686
Mailing Address - Country:US
Mailing Address - Phone:860-918-6379
Mailing Address - Fax:
Practice Address - Street 1:2020 TOWN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6677
Practice Address - Country:US
Practice Address - Phone:860-918-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058946-011223G0001X
390200000X
TN118211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program