Active NPI
John Joseph Richard, DDS
- Oral and Maxillofacial Surgery (Dentist)
- Crystal Lake, IL
National Provider Identifier
1700865441
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- Practice address
- 690 North Route 31
Crystal Lake, IL 60012 - Phone
- (815) 459-5600
- Fax
- (815) 459-5601
- NPI assigned
- Jan 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | IL | Primary |
Addresses
Primary practice location
690 North Route 31
Crystal Lake, IL 60012
Mailing address
9915 Carlisle LN
Village of Lakewood, IL 60014-4819
Phone (815) 444-1533
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019026082 | IL | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700865441",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9915 CARLISLE LN",
"city": "VILLAGE OF LAKEWOOD",
"state": "IL",
"postal_code": "600144819",
"telephone_number": "815-444-1533",
"fax_number": "815-459-5601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "690 NORTH ROUTE 31",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "60012",
"telephone_number": "815-459-5600",
"fax_number": "815-459-5601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARD",
"first_name": "JOHN",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.