MEDICARE: RALPH SHEPSTONE, 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	1223G0001X	General Practice Dentistry	019-020243	IL

General Provider Information

NPI Number	:	1831457639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALPH SHEPSTONE, D.D.S.

Provider Business Mailing Address
First Line	:	3633 WEST LAKE AVE.
Second Line	:	SUITE 304
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	847-998-8989
Fax Number	:	847-998-8983

Provider Business Practice Location Address
First Line	:	3633 WEST LAKE AVE.
Second Line	:	SUITE 304
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5801
Country	:	US
Telephone Number	:	847-998-8989
Fax Number	:	847-998-8983

Authorized Official
Title or Position	:	HEALTH CARE PROVIDER/OWNER
Name	:	DR. RALPH FRANCIS SHEPSTONE
Credential	:	D.D.S.
Telephone Number	:	847-998-8989

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	04/30/2012

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