Provider Demographics
NPI:1215119730
Name:LERIAS, RICHIE VASQUEZ (DDS)
Entity type:Individual
Prefix:
First Name:RICHIE
Middle Name:VASQUEZ
Last Name:LERIAS
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 1:1210 CHICAGO AVE
Mailing Address - Street 2:UNIT 201
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-6513
Mailing Address - Country:US
Mailing Address - Phone:847-328-2054
Mailing Address - Fax:
Practice Address - Street 1:2201 PLUM GROVE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-9404
Practice Address - Country:US
Practice Address - Phone:847-397-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice