Provider Demographics
NPI:1598748816
Name:STEPUSZEK, RICHARD FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRANCIS
Last Name:STEPUSZEK
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 1:900 RAVINIA PL
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4604
Mailing Address - Country:US
Mailing Address - Phone:708-460-1880
Mailing Address - Fax:
Practice Address - Street 1:900 RAVINIA PL
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4604
Practice Address - Country:US
Practice Address - Phone:708-460-1880
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL101249Medicaid