Provider Demographics
NPI:1780742007
Name:RUSS, LESLIE E JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:RUSS
Suffix:JR
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 OGDEN AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7542
Mailing Address - Country:US
Mailing Address - Phone:630-357-7877
Mailing Address - Fax:
Practice Address - Street 1:2124 OGDEN AVE STE 303
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7542
Practice Address - Country:US
Practice Address - Phone:630-357-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist