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General NPI Number Information
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NPI Number | 1841318805
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Entity Type | Organization
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Legal Business Name | RUSSELL J. CECALA, D.D.S., M.S., LTD DBA PERIOCARE
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 7447 W TALCOTT AVE SUITE 227
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-631-0344
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Fax | 773-631-0211
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Provider Business Mailing Address
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Address Line | 7447 W TALCOTT AVE SUITE 227
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-631-0344
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Fax | 773-631-0211
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. RUSSELL J. CECALA
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Credential | D.D.S.,M.S.
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Telephone | 773-631-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | IL
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