Provider Demographics
NPI:1083678940
Name:PLOTKIN, RICHARD J (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:PLOTKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LOCUST WAY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2435
Mailing Address - Country:US
Mailing Address - Phone:610-825-0512
Mailing Address - Fax:
Practice Address - Street 1:26 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3201
Practice Address - Country:US
Practice Address - Phone:610-527-3110
Practice Address - Fax:610-527-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016799L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28650Medicare UPIN
PA104531Medicare ID - Type Unspecified