Provider Demographics
NPI:1427760305
Name:RAYYAN, ADRIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:
Last Name:RAYYAN
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 1:11 BUCKTHORN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9517
Mailing Address - Country:US
Mailing Address - Phone:847-790-4177
Mailing Address - Fax:
Practice Address - Street 1:149 N VIRGINIA ST STE 100
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3494
Practice Address - Country:US
Practice Address - Phone:815-444-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0337811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty