Nirvana L Leix, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19026139 Issued in IL

Practice address

8505 Redtail Drive
Suite J
Village of Lakewood, IL 60014

Phone

(815) 455-8186

Fax

(815) 455-8188

NPI assigned

Nov 15, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Leix Dental PC

  • Dental Clinic/Center
  • Village of Lakewood, IL
  • NPI 1679740138
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210636800000",
    "number": "1043382633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8505 REDTAIL DRIVE",
            "address_2": "SUITE J",
            "city": "VILLAGE OF LAKEWOOD",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-455-8186",
            "fax_number": "815-455-8188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8505 REDTAIL DRIVE",
            "address_2": "SUITE J",
            "city": "VILLAGE OF LAKEWOOD",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-455-8186",
            "fax_number": "815-455-8188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEIX",
        "first_name": "NIRVANA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2008-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19026139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laureen Michele Brotan, LCSW
• Sara R Butler, M.A. CCC SLP L
• Kayla Lynn Dalman
• Susan Lynn Kapustka, DPM
• Leix Dental PC
• Victoria Grace Maurice
• Ashleigh Mauro, FNP-C
• Shannan McNamara, ED. S
• Mindful Growth Psychological Services LLC
• Rachel Mitchell

• All providers in Village of Lakewood, IL
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.