Provider Demographics
NPI:1407066160
Name:WOERHEIDE, RALPH EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:EDWIN
Last Name:WOERHEIDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1862
Mailing Address - Country:US
Mailing Address - Phone:708-748-6179
Mailing Address - Fax:708-748-1441
Practice Address - Street 1:2601 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1862
Practice Address - Country:US
Practice Address - Phone:708-748-6179
Practice Address - Fax:708-748-1441
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190180861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice