Provider Demographics
NPI:1790938678
Name:ALEMAN, RAUL TONY
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:TONY
Last Name:ALEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OAKBROOK CENTER MALL
Mailing Address - Street 2:STE # 802
Mailing Address - City:OAKBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523
Mailing Address - Country:US
Mailing Address - Phone:630-571-3030
Mailing Address - Fax:630-571-1977
Practice Address - Street 1:120 OAKBROOK CENTER MALL
Practice Address - Street 2:STE # 802
Practice Address - City:OAKBROOK
Practice Address - State:IL
Practice Address - Zip Code:60523
Practice Address - Country:US
Practice Address - Phone:630-571-3030
Practice Address - Fax:630-571-1977
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0237091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice