Provider Demographics
NPI:1699947721
Name:RALPH K. ERDMANN, D.D.S., P.C.
Entity type:Organization
Organization Name:RALPH K. ERDMANN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:ERDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-795-0190
Mailing Address - Street 1:6725 STANLEY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3156
Mailing Address - Country:US
Mailing Address - Phone:708-795-0190
Mailing Address - Fax:
Practice Address - Street 1:6725 STANLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3156
Practice Address - Country:US
Practice Address - Phone:708-795-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental