Leslie Danielle Clevenger, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019028307 Issued in IL

Practice address

19665 S la Grange Rd
Mokena, IL 60448-9360

Phone

(708) 479-9888

NPI assigned

Jun 16, 2010

Last updated

Sep 24, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Leon J Witkowski Jr DDS LTD

  • Dentist
  • Mokena, IL
  • NPI 1962536508
  NPD (past)

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1518288356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9735 WARWICK CT",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213569",
            "telephone_number": "765-729-2698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19665 S LA GRANGE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604489360",
            "telephone_number": "708-479-9888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVENGER",
        "first_name": "LESLIE",
        "middle_name": "DANIELLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-16",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011553A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Mokena, IL
• Providers in Mokena, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2019; 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.