Ryan Elston Booth, DDS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Homer Glen, IL
NPI 1578036638 · NPPES record last updated Jan 10, 2019
Key facts
- NPI
- 1578036638
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- 021002799 (IL)
- Practice address
- 12635 W 143Rd St
Homer Glen, IL 60491-8381 - Phone
- (708) 301-0005
- NPI assigned
- Jan 10, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021002799 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry |
1223X0400X | 021002799 | IL | Yes |
Addresses
Primary practice location
12635 W 143Rd St
Homer Glen, IL 60491-8381
Mailing address
12635 W 143Rd St
Homer Glen, IL 60491-8381
Phone (708) 301-0005
Other providers in Homer Glen, IL
- Laura Booker
- Booth Orthodontics LLC
- Booth Orthodontics of Homer Glen LLP
- Barry E Booth
- Evan Booth
- Nicole Eileen Boswell
- Tyler Branson
- Brenczewski Physical Therapy
- Edward J. Brennan
- Derek Brown
All providers in Homer Glen, IL · Orthodontics and Dentofacial Orthopedics Dentistry in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 10, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.