Provider Demographics
NPI:1275664187
Name:DR. RICHARD LANDRY
Entity Type:Organization
Organization Name:DR. RICHARD LANDRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-736-0383
Mailing Address - Street 1:1132 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3878
Mailing Address - Country:US
Mailing Address - Phone:413-736-0383
Mailing Address - Fax:413-732-0536
Practice Address - Street 1:1132 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3878
Practice Address - Country:US
Practice Address - Phone:413-736-0383
Practice Address - Fax:413-732-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI162021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty