Provider Demographics
NPI:1700337359
Name:LEAK LLC
Entity Type:Organization
Organization Name:LEAK LLC
Other - Org Name:VICTORIA G REMIEN BIGG, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:G REMIEN
Authorized Official - Last Name:BIGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-657-9111
Mailing Address - Street 1:2550 COMPASS RD
Mailing Address - Street 2:UNIT L
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1610
Mailing Address - Country:US
Mailing Address - Phone:847-657-9111
Mailing Address - Fax:847-657-9116
Practice Address - Street 1:2550 COMPASS RD
Practice Address - Street 2:UNIT L
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1610
Practice Address - Country:US
Practice Address - Phone:847-657-9111
Practice Address - Fax:847-657-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0197121223G0001X
IL019-0306751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty