Provider Demographics
NPI:1528150695
Name:RASTEDE, DONALD LEE (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LEE
Last Name:RASTEDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-0108
Mailing Address - Country:US
Mailing Address - Phone:815-625-5191
Mailing Address - Fax:
Practice Address - Street 1:1311 DIXON RD
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-1906
Practice Address - Country:US
Practice Address - Phone:815-625-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist