MEDICARE: DR. LESLIE E RUSS JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019020249	IL

General Provider Information

NPI Number	:	1780742007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE E RUSS JR. DDS

Provider Business Mailing Address
First Line	:	2124 OGDEN AVE STE 303
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7542
Country	:	US
Telephone Number	:	630-357-7877
Fax Number	:

Provider Business Practice Location Address
First Line	:	2124 OGDEN AVE STE 303
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7542
Country	:	US
Telephone Number	:	630-357-7877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	04/09/2025

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