Provider Demographics
NPI:1801964986
Name:DI VERDE, RICHARD B (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:DI VERDE
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 1:30 N MICHIGAN AVE STE 1405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4090
Mailing Address - Country:US
Mailing Address - Phone:312-263-7822
Mailing Address - Fax:312-263-7863
Practice Address - Street 1:30 N MICHIGAN AVE STE 1405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4090
Practice Address - Country:US
Practice Address - Phone:312-263-7822
Practice Address - Fax:312-263-7863
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice