Provider Demographics
NPI:1013129881
Name:KESMAN, RUSSELL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:A
Last Name:KESMAN
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 1:1120 OSTRANDER AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-1348
Mailing Address - Country:US
Mailing Address - Phone:708-352-7148
Mailing Address - Fax:708-352-8939
Practice Address - Street 1:129 E VALLETTE ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4477
Practice Address - Country:US
Practice Address - Phone:630-834-3839
Practice Address - Fax:630-834-2434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice