Provider Demographics
NPI:1609881309
Name:SHERYL LEIPOLD D.D.S. P.C.
Entity Type:Organization
Organization Name:SHERYL LEIPOLD D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:708-645-0505
Mailing Address - Street 1:15927 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6707
Mailing Address - Country:US
Mailing Address - Phone:708-645-0505
Mailing Address - Fax:708-301-6066
Practice Address - Street 1:15927 S BELL RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6707
Practice Address - Country:US
Practice Address - Phone:708-645-0505
Practice Address - Fax:708-301-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty