Provider Demographics
NPI:1497447015
Name:MARQUEZ, LEONARDO GABRIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:GABRIEL
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3708
Mailing Address - Country:US
Mailing Address - Phone:712-451-8281
Mailing Address - Fax:
Practice Address - Street 1:4901 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5009
Practice Address - Country:US
Practice Address - Phone:773-509-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0342311223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health