Provider Demographics
NPI:1407948490
Name:HEALY, RICHARD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:HEALY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 S COLLEGE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1302
Mailing Address - Country:US
Mailing Address - Phone:805-928-3928
Mailing Address - Fax:805-928-2248
Practice Address - Street 1:2151 S COLLEGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1302
Practice Address - Country:US
Practice Address - Phone:805-928-3928
Practice Address - Fax:805-928-2248
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30-0344962OtherTIN