Provider Demographics
NPI:1679627608
Name:EHRICH, ROBERT R (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:EHRICH
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 1:1400 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-2030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:809 W DETWEILLER DR
Practice Address - Street 2:SUITE 805A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2149
Practice Address - Country:US
Practice Address - Phone:309-692-1320
Practice Address - Fax:309-692-1355
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-A118011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1005490Medicaid