Provider Demographics
NPI:1801505771
Name:BOGGS, LESLIE TURNER (RDH)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:TURNER
Last Name:BOGGS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 ROCKY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CORRYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37721-2301
Mailing Address - Country:US
Mailing Address - Phone:865-566-2403
Mailing Address - Fax:
Practice Address - Street 1:11556 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5044
Practice Address - Country:US
Practice Address - Phone:865-573-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2375124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist