Individual
LUIS A LECLERES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5002 AIRPORT RD NW STE 130, ROANOKE, VA 24012-1607
(917) 533-3417
Mailing address
5002 AIRPORT RD NW STE 130, ROANOKE, VA 24012-1607
(917) 533-3417
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
0500331
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401416810
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
050033
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
11291
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00050033
—
NY
Enumeration date
04/03/2007
Last updated
12/22/2025
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