Provider Demographics
NPI:1194848408
Name:TESSER, RICHARD ROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ROY
Last Name:TESSER
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 1:652 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4391
Mailing Address - Country:US
Mailing Address - Phone:631-273-3236
Mailing Address - Fax:631-273-5255
Practice Address - Street 1:652 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4391
Practice Address - Country:US
Practice Address - Phone:631-273-3236
Practice Address - Fax:631-273-5255
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0271971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice