Provider Demographics
NPI:1073587036
Name:RICHEY, DAN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:R
Last Name:RICHEY
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 1:8400 OSUNA RD NE
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2070
Mailing Address - Country:US
Mailing Address - Phone:505-292-7747
Mailing Address - Fax:505-294-3557
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 3B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2087
Practice Address - Country:US
Practice Address - Phone:505-292-7747
Practice Address - Fax:505-294-3557
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM11271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice