Provider Demographics
NPI:1952431041
Name:PASIEWICZ, RICHARD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:PASIEWICZ
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 1:1421 ROYAL OAK LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3162
Mailing Address - Country:US
Mailing Address - Phone:847-729-1456
Mailing Address - Fax:
Practice Address - Street 1:5945 S PULASKI RD
Practice Address - Street 2:SUITE 10
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4550
Practice Address - Country:US
Practice Address - Phone:773-776-5905
Practice Address - Fax:773-284-5905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics