Provider Demographics
NPI:1245410984
Name:PHILIP, RITA DIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:DIANA
Last Name:PHILIP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 W ALVA ST
Mailing Address - Street 2:NONE
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2258
Mailing Address - Country:US
Mailing Address - Phone:913-707-0944
Mailing Address - Fax:
Practice Address - Street 1:8770 W BRYN MAWR AVE
Practice Address - Street 2:SUITE 1300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3515
Practice Address - Country:US
Practice Address - Phone:816-922-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist