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General NPI Number Information
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NPI Number | 1366645657
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Entity Type | Individual
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Provider Name | STEVEN BARRY RAPHAEL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 801 S PAULINA ST #301D
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City | CHICAGO
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State | IL
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Zip | 60612-7210
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Country | US
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Telephone | 312-355-3615
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Fax |
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Provider Business Mailing Address
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Address Line | 360 E SOUTH WATER ST #4102
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City | CHICAGO
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State | IL
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Zip | 60601-4028
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Country | US
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Telephone | 913-723-1313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60491
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License Number State | KS
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