Provider Demographics
NPI:1972685055
Name:PACELLI, RICHARD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILLIAM
Last Name:PACELLI
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 1:1400 W 47TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525
Mailing Address - Country:US
Mailing Address - Phone:708-482-4517
Mailing Address - Fax:708-482-4519
Practice Address - Street 1:1400 W 47TH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-482-4517
Practice Address - Fax:708-482-4519
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics