Provider Demographics
NPI:1174972202
Name:RAIBULET, RARES
Entity type:Individual
Prefix:DR
First Name:RARES
Middle Name:
Last Name:RAIBULET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SHERMAN AVE STE 902
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4809
Mailing Address - Country:US
Mailing Address - Phone:847-864-8151
Mailing Address - Fax:
Practice Address - Street 1:1560 SHERMAN AVE STE 902
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4809
Practice Address - Country:US
Practice Address - Phone:847-864-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012518A122300000X
IL019.0317201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist