MEDICARE: DR. RICHARD RAYMOND DEPPE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1205023231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD RAYMOND DEPPE DDS

Provider Business Mailing Address
First Line	:	1021 N MULFORD RD
Second Line	:	SUITE 2
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3877
Country	:	US
Telephone Number	:	815-226-0400
Fax Number	:	815-226-0555

Provider Business Practice Location Address
First Line	:	1021 N MULFORD RD
Second Line	:	SUITE 2
City	:	ROCKFORD
State	:	IL
Zip	:	61107-3877
Country	:	US
Telephone Number	:	815-226-0400
Fax Number	:	815-226-0555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/03/2007

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