MEDICARE: DR. RAY AARON EISSENS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019-026384	IL

General Provider Information

NPI Number	:	1457590069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAY AARON EISSENS D.D.S.

Provider Business Mailing Address
First Line	:	925 OAK ST
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1579
Country	:	US
Telephone Number	:	630-906-9520
Fax Number	:	630-906-1915

Provider Business Practice Location Address
First Line	:	925 OAK ST
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1579
Country	:	US
Telephone Number	:	630-906-9520
Fax Number	:	630-906-1915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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