Provider Demographics
NPI:1891470985
Name:LEANO, ANGELICA (DMD)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:LEANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60133-3413
Mailing Address - Country:US
Mailing Address - Phone:630-402-7479
Mailing Address - Fax:
Practice Address - Street 1:968 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-8329
Practice Address - Country:US
Practice Address - Phone:847-221-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401418420122300000X
IL019.0346541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist