Healthcare Provider Details

I. General information

NPI: 1164422606
Provider Name (Legal Business Name): RICHARD JAMES HRAD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 W 103RD ST SUITE 1A
OAK LAWN IL
60453-4779
US

IV. Provider business mailing address

4647 W 103RD ST SUITE 1A
OAK LAWN IL
60453-4779
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-1700
  • Fax:
Mailing address:
  • Phone: 708-636-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: