Active NPI
Leslie Reeder, DDS
- Dentist
- Evanston, IL
National Provider Identifier
1497740724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019022286
- Practice address
- 636 Church St Ste 722
Evanston, IL 60201-4587 - Phone
- (847) 475-7754
- NPI assigned
- Sep 13, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019022286 | IL | Primary |
Addresses
Primary practice location
636 Church St Ste 722
Evanston, IL 60201-4587
Mailing address
PO Box 525
Highland Park, IL 60035-0525
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031222000860 | IL | Practitioner - Dentist | 3274431630 | Practice locations: Evanston, IL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1497740724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 525",
"city": "HIGHLAND PARK",
"state": "IL",
"postal_code": "600350525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 CHURCH ST STE 722",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014587",
"telephone_number": "847-475-7754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REEDER",
"first_name": "LESLIE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-13",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019022286",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.