Provider Demographics
NPI:1356499719
Name:HACKETT, RICHARD GORDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GORDON
Last Name:HACKETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19703 AVENUE 376
Mailing Address - Street 2:
Mailing Address - City:WOODLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:93286-9747
Mailing Address - Country:US
Mailing Address - Phone:559-308-5167
Mailing Address - Fax:
Practice Address - Street 1:5601 W HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5136
Practice Address - Country:US
Practice Address - Phone:559-635-7186
Practice Address - Fax:559-635-7188
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA227341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice