Healthcare Provider Details

I. General information

NPI: 1114923174
Provider Name (Legal Business Name): NEAL B RICHTER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 BROADWAY STE D
MERRILLVILLE IN
46410-5950
US

IV. Provider business mailing address

8750 BROADWAY STE D
MERRILLVILLE IN
46410-5950
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-4600
  • Fax: 219-769-4933
Mailing address:
  • Phone: 219-769-4600
  • Fax: 219-769-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8029
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: