Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | IL |
NPI | 1013041185 |
---|---|
Provider Name | Dr. Kenneth Raymond Ryback |
First Address | Des Plaines, IL 60016-6465 |
Second Address | Des Plaines, IL 60016-6465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |