Provider Demographics
NPI:1104565399
Name:SAAVEDRA RODRIGUEZ, RAQUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:
Last Name:SAAVEDRA RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 FOREST AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2071
Mailing Address - Country:US
Mailing Address - Phone:786-370-3086
Mailing Address - Fax:
Practice Address - Street 1:956 N NELTNOR BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-5982
Practice Address - Country:US
Practice Address - Phone:630-293-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033652122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist