MEDICARE: R. AARON EISSENS, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	019-026384	IL

General Provider Information

NPI Number	:	1356588941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. AARON EISSENS, DDS, PC

Provider Business Mailing Address
First Line	:	925 OAK ST
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1579
Country	:	US
Telephone Number	:	630-906-9520
Fax Number	:	630-906-1915

Provider Business Practice Location Address
First Line	:	925 OAK ST
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1579
Country	:	US
Telephone Number	:	630-906-9520
Fax Number	:	630-906-1915

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAY AARON EISSENS
Credential	:	D.D.S.
Telephone Number	:	630-906-9520

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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