Provider Demographics
NPI:1578802583
Name:FELT, RICHARD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:FELT
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 1:2443 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1156
Mailing Address - Country:US
Mailing Address - Phone:847-272-0930
Mailing Address - Fax:847-272-0940
Practice Address - Street 1:1275 SHERMER RD
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4558
Practice Address - Country:US
Practice Address - Phone:847-480-1578
Practice Address - Fax:847-480-1579
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0010491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics