Provider Demographics
NPI:1801886544
Name:CONEN, RICHARD S (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:CONEN
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 1:1230 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 1:64 OLD ORCHARD PROFESSIONAL BLDG.
Practice Address - Street 2:SUITE 503
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0208031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice