Individual
DR. LANCE E LESLIE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, MPH
Contact information
Practice address
641 W 63RD ST, CHICAGO, IL 60621-2032
(773) 388-1600
Mailing address
641 W 63RD ST, CHICAGO, IL 60621-2032
(773) 388-1600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019033899
IL
122300000X
Dentist
Primary
30.027368
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019033899
—
IL
Enumeration date
07/13/2022
Last updated
02/06/2025
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