Provider Demographics
NPI:1417985839
Name:BERTOGLIO, RICHARD MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:BERTOGLIO
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 1:1940 W GALENA BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4319
Mailing Address - Country:US
Mailing Address - Phone:630-892-7087
Mailing Address - Fax:
Practice Address - Street 1:1940 W GALENA BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4319
Practice Address - Country:US
Practice Address - Phone:630-892-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice