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Organization
RUSSELL H GERTSCH DDS, PC
Active
Organization
RUSSELL H GERTSCH DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL HAYWARD GERTSCH D.D.S. (PRESIDENT)
(708) 748-8181
Entity
Organization
Contact information
Practice address
4343 SAUK TRL, RICHTON PARK, IL 60471-1254
(708) 748-8181
(708) 748-6002
Mailing address
4343 SAUK TRL, RICHTON PARK, IL 60471-1254
(708) 748-8181
(708) 748-6002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-015925
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019-015925
STATE OF ILLINOIS DENTAL LICENSE
IL
Enumeration date
01/09/2009
Last updated
01/09/2009
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