Provider Demographics
NPI:1821037466
Name:ERDMANN, RALPH KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:KENNETH
Last Name:ERDMANN
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 1:6725 STANLEY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3156
Mailing Address - Country:US
Mailing Address - Phone:708-795-0190
Mailing Address - Fax:708-788-5359
Practice Address - Street 1:6725 STANLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3156
Practice Address - Country:US
Practice Address - Phone:708-795-0190
Practice Address - Fax:708-788-5359
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice