Provider Demographics
NPI:1831464585
Name:RICHARD S. CONEN D.D.S.,LLC
Entity Type:Organization
Organization Name:RICHARD S. CONEN D.D.S.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-372-3327
Mailing Address - Street 1:1230 HILARY LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2342
Mailing Address - Country:US
Mailing Address - Phone:847-372-3327
Mailing Address - Fax:847-831-4413
Practice Address - Street 1:4905 OLD ORCHARD CENTER
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-676-3388
Practice Address - Fax:847-679-3279
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENTLE DENTAL CARE P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0208031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty