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General NPI Number Information
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NPI Number | 1346974581
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Entity Type | Individual
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Provider Name | LANCE E LESLIE III DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 641 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60621-2032
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Country | US
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Telephone | 773-388-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 641 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60621-2032
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Country | US
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Telephone | 773-388-1600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019033899
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.027368
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License Number State | OH
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