Provider Demographics
NPI:1124251814
Name:LEIPOLD, SHERYL (DDS)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:
Last Name:LEIPOLD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15927 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6707
Mailing Address - Country:US
Mailing Address - Phone:708-645-0505
Mailing Address - Fax:708-301-6066
Practice Address - Street 1:15927 S BELL RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6707
Practice Address - Country:US
Practice Address - Phone:708-645-0505
Practice Address - Fax:708-301-6066
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist