Healthcare Provider Details

I. General information

NPI: 1891470985
Provider Name (Legal Business Name): ANGELICA LEANO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 CRAB TREE LN
BARTLETT IL
60103-2115
US

IV. Provider business mailing address

729 CRAB TREE LN
BARTLETT IL
60103-2115
US

V. Phone/Fax

Practice location:
  • Phone: 630-402-7479
  • Fax:
Mailing address:
  • Phone: 630-402-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418420
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: