Provider Demographics
NPI:1104441005
Name:RISUS ORTHODONTICS
Entity type:Organization
Organization Name:RISUS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNNEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD, MS
Authorized Official - Phone:312-317-5647
Mailing Address - Street 1:1340 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4598
Mailing Address - Country:US
Mailing Address - Phone:847-272-7550
Mailing Address - Fax:
Practice Address - Street 1:1340 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4598
Practice Address - Country:US
Practice Address - Phone:847-272-7550
Practice Address - Fax:847-272-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty