Provider Demographics
NPI:1598988065
Name:RUSSELL T. RAS, DDS,LTD.
Entity Type:Organization
Organization Name:RUSSELL T. RAS, DDS,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:RAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-354-2227
Mailing Address - Street 1:6538 JOLIET RD
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-4649
Mailing Address - Country:US
Mailing Address - Phone:708-354-2227
Mailing Address - Fax:708-354-2367
Practice Address - Street 1:6538 JOLIET RD
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-4649
Practice Address - Country:US
Practice Address - Phone:708-354-2227
Practice Address - Fax:708-354-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.020398261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental