Provider Demographics
NPI:1265473938
Name:ZIEGLER, RICHARD W (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:ZIEGLER
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 1:6903 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2919
Mailing Address - Country:US
Mailing Address - Phone:708-795-4288
Mailing Address - Fax:
Practice Address - Street 1:6903 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2919
Practice Address - Country:US
Practice Address - Phone:708-795-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-019096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL319-008545OtherCS LICENSE
IL019-019096Medicaid
IL019-019096Medicaid
ILU86768Medicare UPIN