MEDICARE: DR. STEVAN ORSER 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	19A-15229	IL

General Provider Information

NPI Number	:	1669561981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVAN ORSER D.D.S.

Provider Business Mailing Address
First Line	:	675 RILEY LN
Second Line	:
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2794
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 E RAND RD
Second Line	:	SUITE 200
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-4356
Country	:	US
Telephone Number	:	847-870-8820
Fax Number	:	847-870-8912

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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