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General NPI Number Information
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NPI Number | 1508163692
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Entity Type | Organization
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Legal Business Name | LERIAS & QUESEA DDS PC
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 142 W IRVING PARK RD
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City | WOOD DALE
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State | IL
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Zip | 60191-1341
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Country | US
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Telephone | 630-766-3840
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Fax |
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Provider Business Mailing Address
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Address Line | 142 W. IRVING PARK RD
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City | WOOD DALE
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State | IL
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Zip | 60191
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Country | US
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Telephone | 630-766-3840
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RICHIE V LERIAS
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Credential |
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Telephone | 630-766-3840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019-026070
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License Number State | IL
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