Provider Demographics
NPI:1164482741
Name:MUNARETTO, RICHARD ALEX (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALEX
Last Name:MUNARETTO
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 1:7603 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1133
Mailing Address - Country:US
Mailing Address - Phone:708-456-7787
Mailing Address - Fax:708-689-0853
Practice Address - Street 1:7603 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1133
Practice Address - Country:US
Practice Address - Phone:708-456-7787
Practice Address - Fax:708-689-0853
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL21-20711223E0200X
IL19-0256341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice