Individual
DR. JONATHAN KENNETH RAKSTANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7820 S CICERO AVE, BURBANK, IL 60459-1584
(708) 391-5220
Mailing address
547 S CLARK ST APT 1004, CHICAGO, IL 60605-1548
(303) 669-8175
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3740
AR
122300000X
Dentist
8923
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
019.032870
IL
Other
Enumeration date
12/29/2009
Last updated
09/08/2021
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