Provider Demographics
NPI:1740964998
Name:BANOS, LESLY Y (DMD)
Entity type:Individual
Prefix:
First Name:LESLY
Middle Name:Y
Last Name:BANOS
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 1:4421 OLMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-1141
Mailing Address - Country:US
Mailing Address - Phone:630-229-7528
Mailing Address - Fax:
Practice Address - Street 1:7310 WALTON ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-4614
Practice Address - Country:US
Practice Address - Phone:815-395-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist