Provider Demographics
NPI:1124032388
Name:MCDANIEL, RICHARD T (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:T
Last Name:MCDANIEL
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 1:997 CLOCK TOWER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1301
Mailing Address - Country:US
Mailing Address - Phone:217-546-9600
Mailing Address - Fax:217-546-9642
Practice Address - Street 1:997 CLOCK TOWER DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1301
Practice Address - Country:US
Practice Address - Phone:217-546-9600
Practice Address - Fax:217-546-9642
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics