Provider Demographics
NPI:1952503765
Name:RISTY, MICHAEL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:RISTY
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 1:13544 W. ROUTE 30
Mailing Address - Street 2:UNIT A
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585
Mailing Address - Country:US
Mailing Address - Phone:815-577-9000
Mailing Address - Fax:815-230-3900
Practice Address - Street 1:13544 W. ROUTE 30
Practice Address - Street 2:UNIT A
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585
Practice Address - Country:US
Practice Address - Phone:815-577-9000
Practice Address - Fax:815-230-3900
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice