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NPI Code Detail

MEDICARE: RISORIUS DENTAL LLC

MEDICARE: RISORIUS DENTAL LLC
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
1261QD0000XDental Clinic/Center019028082IL

General Provider Information

NPI Number : 1699908509
Entity Type Code : Organization
Provider Name (Legal Business Name) : RISORIUS DENTAL LLC
Provider Business Mailing Address
First Line : 9211 WAUKEGAN RD
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2102
Country : US
Telephone Number : 847-965-9211
Fax Number :
Provider Business Practice Location Address
First Line : 9211 WAUKEGAN RD
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-2102
Country : US
Telephone Number : 847-965-9211
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. VLAD BOTEZATU
Credential : DMD
Telephone Number : 847-965-9211
Provider Enumeration Date : 08/25/2009
Last Update Date : 08/25/2009

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Directions to “RISORIUS DENTAL LLC ” Practice Location

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