Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 021.002196 | IL |
NPI | 1073673323 |
---|---|
Provider Name | Dr. Joshua Adam Ries |
First Address | Chicago, IL 60614-1705 |
Second Address | Chicago, IL 60611-2213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 16/07/2015 |