Leanne Fredrickson, D.D.S.
Individual provider Active NPI General Practice Dentistry · North Chicago, IL
NPI 1528070463 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1528070463
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Practice address
- 3001 Green Bay Rd
M/C 160
North Chicago, IL 60064-3048 - Phone
- (224) 610-3749
- Fax
- (224) 610-2909
- NPI assigned
- Aug 12, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130627000164 | IL | Order and Referring Only - Oral Surgery |
2860631637 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019 023550 | IL | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | IL | Yes |
Addresses
Primary practice location
3001 Green Bay Rd
M/C 160
North Chicago, IL 60064-3048
Mailing address
2847 Rose St
Franklin Park, IL 60131-2961
Other providers in North Chicago, IL
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- Ramil M Francisco
- Kristen Abbi Fregoso
- Kamila Frejowska
- Lenore Elizabeth Frydrychowicz
- Darnell Frye II
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All providers in North Chicago, IL · General Practice Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.