Provider Demographics
NPI:1871625012
Name:LEUNG, ROMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:LEUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELK GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-593-3222
Mailing Address - Fax:847-593-1850
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ELK GROVE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-593-3222
Practice Address - Fax:847-593-1850
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics