MEDICARE: LEON RAZ DDS, SC

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	1223G0001X	General Practice Dentistry	019018530	IL

General Provider Information

NPI Number	:	1588707525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEON RAZ DDS, SC

Provider Business Mailing Address
First Line	:	180 MILWAUKEE AVE
Second Line	:	STE 103
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1840
Country	:	US
Telephone Number	:	847-465-9676
Fax Number	:	847-465-9710

Provider Business Practice Location Address
First Line	:	180 MILWAUKEE AVE
Second Line	:	STE 103
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1840
Country	:	US
Telephone Number	:	847-465-9676
Fax Number	:	847-465-9710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEONID RAZDOLSKY
Credential	:	DDS
Telephone Number	:	846-465-9676

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	10/17/2014

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