Provider Demographics
NPI:1437594793
Name:JUNE, RICHARD PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:JUNE
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 1:10605 N SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1121
Mailing Address - Country:US
Mailing Address - Phone:309-693-3806
Mailing Address - Fax:309-693-0719
Practice Address - Street 1:309 EDWARD ST
Practice Address - Street 2:
Practice Address - City:HENRY
Practice Address - State:IL
Practice Address - Zip Code:61537-1501
Practice Address - Country:US
Practice Address - Phone:309-364-3981
Practice Address - Fax:309-364-3984
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19015132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist