Provider Demographics
NPI:1831457639
Name:RALPH SHEPSTONE, D.D.S.
Entity Type:Organization
Organization Name:RALPH SHEPSTONE, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:SHEPSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-998-8989
Mailing Address - Street 1:3633 WEST LAKE AVE.
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5801
Mailing Address - Country:US
Mailing Address - Phone:847-998-8989
Mailing Address - Fax:847-998-8983
Practice Address - Street 1:3633 WEST LAKE AVE.
Practice Address - Street 2:SUITE 304
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5801
Practice Address - Country:US
Practice Address - Phone:847-998-8989
Practice Address - Fax:847-998-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0202431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty