Provider Demographics
NPI:1134416407
Name:SIEGFRIED, LESLIE ERIN (DDS)
Entity type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:ERIN
Last Name:SIEGFRIED
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:ERIN
Other - Last Name:RINGGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12 MARLOU DRIVE
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-628-5555
Mailing Address - Fax:501-628-5556
Practice Address - Street 1:2626 MERCHANTS WALK
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-2863
Practice Address - Country:US
Practice Address - Phone:615-225-8903
Practice Address - Fax:615-225-8915
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197469608Medicaid