MEDICARE: DR. EVAN RYAN HUFFSTEDTLER DMD

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	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1558293209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN RYAN HUFFSTEDTLER DMD

Provider Business Mailing Address
First Line	:	1424 HOLMES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-3726
Country	:	US
Telephone Number	:	217-652-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	13442 CICERO AVE
Second Line	:
City	:	CRESTWOOD
State	:	IL
Zip	:	60418-1430
Country	:	US
Telephone Number	:	708-393-4911
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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