Provider Demographics
NPI:1144309733
Name:PURDUE, RICHARD (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:PURDUE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 S ROSELLE RD
Mailing Address - Street 2:SUITE #205
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5540
Mailing Address - Country:US
Mailing Address - Phone:847-301-1112
Mailing Address - Fax:
Practice Address - Street 1:129 S ROSELLE RD
Practice Address - Street 2:SUITE #205
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-5540
Practice Address - Country:US
Practice Address - Phone:847-301-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist