Provider Demographics
NPI:1710094768
Name:RUTHERFORD, LESLEE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLEE
Middle Name:D
Last Name:RUTHERFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7131-A S JEFFERY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:773-256-0526
Mailing Address - Fax:773-363-5493
Practice Address - Street 1:7131-A SOUTH JEFFERY BOULEVARD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-256-0256
Practice Address - Fax:773-363-5493
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-026451122300000X
IL021.0023971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist