Provider Demographics
NPI:1851401962
Name:WELINDT, RICHARD TAGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TAGE
Last Name:WELINDT
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 1:1515 N HARLEM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1250
Mailing Address - Country:US
Mailing Address - Phone:708-848-2853
Mailing Address - Fax:708-848-1330
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:708-848-2853
Practice Address - Fax:708-848-1330
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist