PEDIATRIC DENTISTRY OF LEBANON,PLLC
NPI 1710434204
Dentist - Pediatric Dentistry in Lebanon, TN

Q: What is Pediatric Dentistry Of Lebanon,pllc's NPI number?

The NPI number for Pediatric Dentistry Of Lebanon,pllc is 1710434204. It was assigned to this organization in the NPPES registry on September 1, 2016.

Q: What is Pediatric Dentistry Of Lebanon,pllc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Active since September 01, 2016

103 PHYSICIANS WAY, STE 150, LEBANON, TN 37090(615) 545-1812 Get Directions Write a Review

NPPES record last updated: September 1, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Pediatric Dentistry Of Lebanon,pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRIC DENTISTRY OF LEBANON,PLLC (NPI 1710434204) is a healthcare organization registered as a pediatric dentistry in Lebanon, Tennessee and active in the NPI registry since September 2016. The organization lists Leslie Suzanne Wallace, Dentist, as its authorized official.

NPPES Registry Identity

NPI1710434204

Entity TypeOrganization

Primary Taxonomy1223P0221X

Legal Business NamePEDIATRIC DENTISTRY OF LEBANON,PLLC

Location Address103 PHYSICIANS WAY, STE 150Lebanon, TN 37090-4132

Mailing Address103 Physicians Way, Ste 150Lebanon, TN 37090-4132 · (615) 545-1812

Phone(615) 545-1812

Organization SubpartNo

Authorized OfficialLeslie Suzanne WallaceDentist · (615) 545-1812

Enumeration DateSeptember 1, 2016

✔ NPI 1710434204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

License✔ Licensed in TN · 8973

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

103 PHYSICIANS WAY, Lebanon, TN 37090

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Other Identifiers 1

Medicaid1514855TN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LESLIE SUZANNE WALLACE DMD

Dentist (Pediatric Dentistry)

103 PHYSICIANS WAY, SUITE 150
LEBANON, TN 37090

Wilson County (859) 948-0386

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pediatric Dentistry Of Lebanon,pllc's NPI number?

The NPI number for Pediatric Dentistry Of Lebanon,pllc is 1710434204. It was assigned to this organization in the NPPES registry on September 1, 2016.

Where is Pediatric Dentistry Of Lebanon,pllc located?

Pediatric Dentistry Of Lebanon,pllc is located at 103 Physicians Way Ste 150, Lebanon, TN 37090. The listed phone number is (615) 545-1812.

What is Pediatric Dentistry Of Lebanon,pllc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

When was this NPI record last updated?

The NPPES record for Pediatric Dentistry Of Lebanon,pllc was last updated on September 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.