Provider Demographics
NPI:1346415924
Name:RICHARD J OSMANSKI, DDS PC
Entity Type:Organization
Organization Name:RICHARD J OSMANSKI, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JUDE
Authorized Official - Last Name:OSMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-854-7806
Mailing Address - Street 1:6 LAUREL VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5939
Mailing Address - Country:US
Mailing Address - Phone:847-854-7806
Mailing Address - Fax:847-854-7806
Practice Address - Street 1:77 E CRYSTAL LAKE AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6171
Practice Address - Country:US
Practice Address - Phone:815-459-8650
Practice Address - Fax:815-455-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190216921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty