Provider Demographics
NPI:1417071416
Name:GARTNER, RICHARD RAY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAY
Last Name:GARTNER
Suffix:JR
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 1:900 RITCHIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4142
Mailing Address - Country:US
Mailing Address - Phone:410-647-0200
Mailing Address - Fax:410-315-8456
Practice Address - Street 1:900 RITCHIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4142
Practice Address - Country:US
Practice Address - Phone:410-647-0200
Practice Address - Fax:410-315-8456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD62411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics