Individual
RUSSELL A BAER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
222 N LASALLE ST, 230, CHICAGO, IL 60601-1002
(773) 834-4064
Mailing address
5841 S MARYLAND AVE # MC1099, CHICAGO, IL 60637-1447
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019019898
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019019898
—
IL
Enumeration date
12/22/2006
Last updated
03/03/2021
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