Provider Demographics
NPI:1841318805
Name:RUSSELL J. CECALA, D.D.S., M.S., LTD DBA PERIOCARE
Entity type:Organization
Organization Name:RUSSELL J. CECALA, D.D.S., M.S., LTD DBA PERIOCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CECALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:773-631-0344
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-0344
Mailing Address - Fax:773-631-0211
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-0344
Practice Address - Fax:773-631-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty