Provider Demographics
NPI:1205023231
Name:DEPPE, RICHARD RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAYMOND
Last Name:DEPPE
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 1:1021 N MULFORD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3877
Mailing Address - Country:US
Mailing Address - Phone:815-226-0400
Mailing Address - Fax:815-226-0555
Practice Address - Street 1:1021 N MULFORD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3877
Practice Address - Country:US
Practice Address - Phone:815-226-0400
Practice Address - Fax:815-226-0555
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist