Provider Demographics
NPI:1629799655
Name:CHERAGHI, LEILA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:
Last Name:CHERAGHI
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 1:465 W RAVENSWOOD HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3507
Mailing Address - Country:US
Mailing Address - Phone:262-299-7773
Mailing Address - Fax:
Practice Address - Street 1:465 W RAVENSWOOD HILLS CIR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-3507
Practice Address - Country:US
Practice Address - Phone:262-299-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1003828-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty