Individual
DR. RICHARD KEITH USEDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6050 BRYNWOOD DR STE 106, ROCKFORD, IL 61114-6579
(815) 877-3565
Mailing address
6050 BRYNWOOD DR STE 106, ROCKFORD, IL 61114-6579
(815) 877-3565
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019018382
IL
Other
Enumeration date
07/22/2008
Last updated
07/22/2008
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