IndividualActive
Derrick Richard, DMD
NPI 1083757702 · General Practice Dentistry · Waterloo, IL
Provider details
- NPI number
- 1083757702
- Entity type
- Individual
- Primary specialty
- General Practice DentistryDental Providers
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- License
- 019-024830 (IL)
Specialties & taxonomies
Dental Providers
Practice location
226 Westview Plaza Dr.
Waterloo, IL 62298-1253
Phone: (618) 939-4042
Fax: (618) 939-5404
Approximate (ZIP-level) locationGet directions
Mailing address
226 Westview Plaza Dr.
Waterloo, IL 62298-1253
Registry dates
- Enumerated
- 2007-02-14
- Last updated
- 2015-04-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.