Provider Demographics
NPI:1669110144
Name:LOPEZ, LESLIE JANET (DDS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:JANET
Last Name:LOPEZ
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 1:401 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2112
Mailing Address - Country:US
Mailing Address - Phone:505-306-9257
Mailing Address - Fax:
Practice Address - Street 1:28365 DAVIS PKWY STE 206
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3034
Practice Address - Country:US
Practice Address - Phone:505-306-9257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program