Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 19-013654 | IL |
Y | 1223E0200X | Endodontist | 21-001023 | IL |
NPI | 1124097654 |
---|---|
Provider Name | Dr. Richard A Munaretto |
First Address | River Forest, IL 60305-1133 |
Second Address | River Forest, IL 60305-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 02/11/2016 |