Provider Demographics
NPI:1558684795
Name:ISRAEL, MATTHEW H (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:H
Last Name:ISRAEL
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:2401 RAVINE WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7645
Mailing Address - Country:US
Mailing Address - Phone:847-486-0255
Mailing Address - Fax:847-486-0293
Practice Address - Street 1:2401 RAVINE WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7645
Practice Address - Country:US
Practice Address - Phone:847-486-0255
Practice Address - Fax:847-486-0293
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL021.0022311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics