Healthcare Provider Details

I. General information

NPI: 1104285972
Provider Name (Legal Business Name): RICHARD F. CALLAHAN, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRIARCLIFF PROFESSIONAL CENTER
BOURBONNAIS IL
60914-1775
US

IV. Provider business mailing address

10 BRIARCLIFF PROFESSIONAL CENTER
BOURBONNAIS IL
60914
US

V. Phone/Fax

Practice location:
  • Phone: 815-939-2585
  • Fax: 815-939-7857
Mailing address:
  • Phone: 815-939-2585
  • Fax: 815-939-7857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD F. CALLAHAN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 815-939-2585