Provider Demographics
NPI:1952438509
Name:MONAHAN, RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2211 N OAK PARK AVE
Mailing Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3351
Mailing Address - Country:US
Mailing Address - Phone:773-622-5400
Mailing Address - Fax:773-385-5830
Practice Address - Street 1:2211 N OAK PARK AVE
Practice Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3351
Practice Address - Country:US
Practice Address - Phone:773-622-5400
Practice Address - Fax:773-385-5830
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology