Provider Demographics
NPI:1013191618
Name:MCDERMOTT, RICHARD EMER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EMER
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3052
Mailing Address - Country:US
Mailing Address - Phone:636-343-3633
Mailing Address - Fax:
Practice Address - Street 1:3006 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8675
Practice Address - Country:US
Practice Address - Phone:636-978-8848
Practice Address - Fax:636-978-0240
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050312671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics