Provider Demographics
NPI:1871753012
Name:GUERRA, RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GUERRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4108
Mailing Address - Country:US
Mailing Address - Phone:773-763-6116
Mailing Address - Fax:773-763-6116
Practice Address - Street 1:5318 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4108
Practice Address - Country:US
Practice Address - Phone:773-763-6116
Practice Address - Fax:773-763-6116
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190276131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice