Provider Demographics
NPI:1861677270
Name:SEMRAU, CARL F (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:F
Last Name:SEMRAU
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 1:34 WEST 63RD ST.
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2981
Mailing Address - Country:US
Mailing Address - Phone:630-655-3883
Mailing Address - Fax:630-655-3957
Practice Address - Street 1:34 63RD ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2981
Practice Address - Country:US
Practice Address - Phone:630-655-3883
Practice Address - Fax:630-655-3957
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-167031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019-16703OtherSTATE ID#