Provider Demographics
NPI:1619793072
Name:MARCUM, LEISHA ALLISON (RDH)
Entity type:Individual
Prefix:MRS
First Name:LEISHA
Middle Name:ALLISON
Last Name:MARCUM
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 1:7000 DITTY RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-6506
Mailing Address - Country:US
Mailing Address - Phone:423-215-7766
Mailing Address - Fax:
Practice Address - Street 1:1265 INTERSTATE DR STE 101
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-5198
Practice Address - Country:US
Practice Address - Phone:931-783-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8429124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist