Provider Demographics
NPI:1417260159
Name:ULRICH, RICHARD
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:ULRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3067
Mailing Address - Country:US
Mailing Address - Phone:630-420-1212
Mailing Address - Fax:630-420-0300
Practice Address - Street 1:6 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3067
Practice Address - Country:US
Practice Address - Phone:630-420-1212
Practice Address - Fax:630-420-0300
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190163001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1699986976Medicaid