Provider Demographics
NPI:1922265578
Name:RUSSELL P UMBRICHT DDS LTD
Entity Type:Organization
Organization Name:RUSSELL P UMBRICHT DDS LTD
Other - Org Name:LATHROP ORAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:UMBRICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-366-8907
Mailing Address - Street 1:404 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1810
Mailing Address - Country:US
Mailing Address - Phone:708-366-8909
Mailing Address - Fax:708-366-8909
Practice Address - Street 1:404 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1810
Practice Address - Country:US
Practice Address - Phone:708-366-8909
Practice Address - Fax:708-366-8909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060000462041138603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty