Individual
DR. MARY RASTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2400 BELVIDERE RD, WAUKEGAN, IL 60085-6165
(847) 984-5330
Mailing address
870 BELMAR LN, BUFFALO GROVE, IL 60089-1350
(847) 465-0127
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019025325
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019025325
—
IL
01
—
1005423
DOREL
IL
Enumeration date
11/23/2005
Last updated
12/19/2008
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