Provider Demographics
NPI:1679643274
Name:PATRICK, LEAH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:M
Last Name:PATRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E COLLEGE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-1886
Mailing Address - Country:US
Mailing Address - Phone:615-446-7878
Mailing Address - Fax:615-446-4116
Practice Address - Street 1:320 E COLLEGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1886
Practice Address - Country:US
Practice Address - Phone:615-446-7878
Practice Address - Fax:615-446-4116
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS69201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice