Individual
DERRICK L RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
226 WESTVIEW PLAZA DR., WATERLOO, IL 62298-1253
(618) 939-4042
(618) 939-5404
Mailing address
226 WESTVIEW PLAZA DR., WATERLOO, IL 62298-1253
(618) 939-4042
(618) 939-5404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-024830
IL
Other
Enumeration date
02/14/2007
Last updated
04/19/2015
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