Provider Demographics
NPI:1912454810
Name:KLECZEK, LESLIE (DMD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:KLECZEK
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 1:217 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GALVA
Mailing Address - State:IL
Mailing Address - Zip Code:61434-1766
Mailing Address - Country:US
Mailing Address - Phone:309-932-2000
Mailing Address - Fax:
Practice Address - Street 1:217 MARKET ST
Practice Address - Street 2:
Practice Address - City:GALVA
Practice Address - State:IL
Practice Address - Zip Code:61434-1766
Practice Address - Country:US
Practice Address - Phone:309-932-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist