Provider Demographics
NPI:1093831539
Name:DARE, RICHARD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
Last Name:DARE
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 1:2571 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561
Mailing Address - Country:US
Mailing Address - Phone:925-625-8050
Mailing Address - Fax:925-625-8084
Practice Address - Street 1:2571 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561
Practice Address - Country:US
Practice Address - Phone:925-625-8050
Practice Address - Fax:925-625-8084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0314531223G0001X
CADH031453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice