Provider Demographics
NPI:1265470041
Name:BARICHELLO, WAYNE RAYMOND (DMD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:RAYMOND
Last Name:BARICHELLO
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 1:602 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2337
Mailing Address - Country:US
Mailing Address - Phone:503-656-8250
Mailing Address - Fax:
Practice Address - Street 1:602 MONROE ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2337
Practice Address - Country:US
Practice Address - Phone:503-656-8250
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD4594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist