Provider Demographics
NPI:1104285972
Name:RICHARD F. CALLAHAN, LTD.
Entity type:Organization
Organization Name:RICHARD F. CALLAHAN, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-939-2585
Mailing Address - Street 1:10 BRIARCLIFF PROFESSIONAL CENTER
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914
Mailing Address - Country:US
Mailing Address - Phone:815-939-2585
Mailing Address - Fax:815-939-7857
Practice Address - Street 1:10 BRIARCLIFF PROFESSIONAL CENTER
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1775
Practice Address - Country:US
Practice Address - Phone:815-939-2585
Practice Address - Fax:815-939-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty