Provider Demographics
NPI:1477637320
Name:ATWOOD, RICK DALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:DALE
Last Name:ATWOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 MAINE ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5843
Mailing Address - Country:US
Mailing Address - Phone:217-224-7718
Mailing Address - Fax:
Practice Address - Street 1:3915 MAINE ST
Practice Address - Street 2:SUITE #2
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5843
Practice Address - Country:US
Practice Address - Phone:217-224-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice