Provider Demographics
NPI:1730312380
Name:KURT W. RAACK, M.S., D.D.S., P.C.
Entity Type:Organization
Organization Name:KURT W. RAACK, M.S., D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-262-8686
Mailing Address - Street 1:2700 KESLINGER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4645
Mailing Address - Country:US
Mailing Address - Phone:630-262-8686
Mailing Address - Fax:630-262-8685
Practice Address - Street 1:2700 KESLINGER RD
Practice Address - Street 2:SUITE A
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4645
Practice Address - Country:US
Practice Address - Phone:630-262-8686
Practice Address - Fax:630-262-8685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1396961215OtherTYPE 1 NPI