Rasty, Mary
Rasty, Mary is an individual health care provider with primary practice located at 2400 Belvidere Rd , Waukegan IL 60085-6165. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Rasty, Mary can be contacted via phone (847) 984-5330.Contact Information
Primary practice address
2400 Belvidere Rd
Waukegan IL 60085-6165
Phone: (847) 984-5330
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 019025325 | Illinois |
Profile Details
| NPI number | 1437132412 |
|---|---|
| LBN Legal business name | Rasty, Mary |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 23rd, 2005 |
| Last updated | Dec 19th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1437132412 | NPPES |
| Illinois | MEDICAID | 019025325 | |
| Illinois | Other | 1005423 |
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