Provider Demographics
NPI:1174505663
Name:TYE, RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TYE
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 1:2539 MARIAN LN
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2205
Mailing Address - Country:US
Mailing Address - Phone:847-492-3494
Mailing Address - Fax:847-492-3499
Practice Address - Street 1:1800 SHERMAN AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3777
Practice Address - Country:US
Practice Address - Phone:847-492-3492
Practice Address - Fax:847-492-3499
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A15002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist