Provider Demographics
NPI:1821154907
Name:KRUGER, RICHARD CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:KRUGER
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 1:9101 N GREENWOOD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1466
Mailing Address - Country:US
Mailing Address - Phone:847-827-0660
Mailing Address - Fax:847-827-0689
Practice Address - Street 1:9101 N GREENWOOD AVE STE 204
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1466
Practice Address - Country:US
Practice Address - Phone:847-827-0660
Practice Address - Fax:847-827-0689
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice