Provider Demographics
NPI:1366820797
Name:BANDLEY, RICHARD ANDREW (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANDREW
Last Name:BANDLEY
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 1:14010 HORIZON BLVD STE S
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7084
Mailing Address - Country:US
Mailing Address - Phone:915-260-8666
Mailing Address - Fax:915-260-8551
Practice Address - Street 1:14010 HORIZON BLVD STE S
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7084
Practice Address - Country:US
Practice Address - Phone:915-260-8666
Practice Address - Fax:915-260-8551
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice