Provider Demographics
NPI:1508163692
Name:LERIAS & QUESEA DDS PC
Entity Type:Organization
Organization Name:LERIAS & QUESEA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:LERIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-766-3840
Mailing Address - Street 1:142 W. IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191
Mailing Address - Country:US
Mailing Address - Phone:630-766-3840
Mailing Address - Fax:
Practice Address - Street 1:142 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1341
Practice Address - Country:US
Practice Address - Phone:630-766-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0260701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty