Provider Demographics
NPI:1912783705
Name:LESLIE M SANDERS DDS PC
Entity Type:Organization
Organization Name:LESLIE M SANDERS DDS PC
Other - Org Name:WICKER PARK DENTAL STUDIO, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-346-9383
Mailing Address - Street 1:3604 N CAMPBELL AVE UNIT 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4726
Mailing Address - Country:US
Mailing Address - Phone:630-346-9383
Mailing Address - Fax:
Practice Address - Street 1:1282 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-9319
Practice Address - Country:US
Practice Address - Phone:312-392-0885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty