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General NPI Number Information
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NPI Number | 1154112472
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Entity Type | Organization
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Legal Business Name | RAVENSWOOD DENTAL PLLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 5015 N PAULINA ST STE 330
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City | CHICAGO
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State | IL
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Zip | 60640-2756
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Country | US
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Telephone | 773-774-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 SHERIDAN RD UNIT UL102
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City | WILMETTE
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State | IL
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Zip | 60091-1838
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Country | US
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Telephone | 847-648-1980
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THEODORE SIEGEL
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Credential |
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Telephone | 773-772-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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