Provider Demographics
NPI:1598189201
Name:DR. RICARDO G. TAPIADOR
Entity Type:Organization
Organization Name:DR. RICARDO G. TAPIADOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAPIADOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-662-2121
Mailing Address - Street 1:1616 GRAND AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3676
Mailing Address - Country:US
Mailing Address - Phone:847-662-2121
Mailing Address - Fax:847-625-9688
Practice Address - Street 1:1616 GRAND AVENUE,
Practice Address - Street 2:STE. 106
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-662-2121
Practice Address - Fax:847-625-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-A15676302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization