Provider Demographics
NPI:1093282972
Name:RICHARD, MARKUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARKUS
Middle Name:
Last Name:RICHARD
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 1:20591 ARDORE LN
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6381
Mailing Address - Country:US
Mailing Address - Phone:239-834-7178
Mailing Address - Fax:
Practice Address - Street 1:1 PLACE NOTRE DAME # 1
Practice Address - Street 2:
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2521
Practice Address - Country:US
Practice Address - Phone:802-748-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23802122300000X
WADE61250032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist