Provider Demographics
NPI:1629243076
Name:OSMANSKI, RICHARD JUDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JUDE
Last Name:OSMANSKI
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 1:6 LAUREL VALLEY COURT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156
Mailing Address - Country:US
Mailing Address - Phone:847-854-7806
Mailing Address - Fax:847-854-7806
Practice Address - Street 1:77 E CRYSTAL LAKE AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6171
Practice Address - Country:US
Practice Address - Phone:815-459-8650
Practice Address - Fax:815-455-9503
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190216921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice