Provider Demographics
NPI:1356414437
Name:DELCARLO, RICHARD DAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAN
Last Name:DELCARLO
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 1:6440 MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1752
Mailing Address - Country:US
Mailing Address - Phone:630-241-3904
Mailing Address - Fax:630-420-1050
Practice Address - Street 1:6440 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1752
Practice Address - Country:US
Practice Address - Phone:630-241-3904
Practice Address - Fax:630-420-1050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190140351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice