Provider Demographics
NPI:1376762427
Name:ANDERSON, RICHARD C (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:ANDERSON
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:PO BOX 494
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-0494
Mailing Address - Country:US
Mailing Address - Phone:478-934-7700
Mailing Address - Fax:478-934-8080
Practice Address - Street 1:208 SE THIRD STREET
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-0494
Practice Address - Country:US
Practice Address - Phone:478-934-7700
Practice Address - Fax:478-934-8080
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist