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General NPI Number Information
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NPI Number | 1487285482
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Entity Type | Organization
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Legal Business Name | RICHARD RAZDOLSKY DDS LLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 3800 WILLOW RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-6147
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Country | US
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Telephone | 224-355-1118
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Fax |
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Provider Business Mailing Address
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Address Line | 227 BRAMPTON LN
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City | LAKE FOREST
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State | IL
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Zip | 60045-4706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD RAZDOLSKY
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Credential | DDS
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Telephone | 847-980-6570
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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 |
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License Number State |
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