Provider Demographics
NPI:1275212391
Name:DEMASK, RITA M (RDH, PHDH)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:DEMASK
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 RENTSCH DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-5429
Mailing Address - Country:US
Mailing Address - Phone:309-369-3586
Mailing Address - Fax:
Practice Address - Street 1:1177 RENTSCH DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-5429
Practice Address - Country:US
Practice Address - Phone:309-369-3586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.006993124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist