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General NPI Number Information
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NPI Number | 1518540285
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Entity Type | Individual
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Provider Name | LISA ANN RAWLE B.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | UIC PEDIATRIC DENTISTRY RESIDENCY RM 256D (MC 850) 801 S. PAULINA ST.
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City | CHICAGO
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State | IL
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Zip | 60613
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Country | US
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Telephone | 312-413-7714
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Fax | 312-996-1981
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Provider Business Mailing Address
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Address Line | UIC PEDIATRIC DENTISTRY 801 S. PAULINA ST. MC 850
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 866-600-2273
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019.035456
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License Number State | IL
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