Provider Demographics
NPI:1427217686
Name:DR. RICHARD C. APODACA, PC
Entity Type:Organization
Organization Name:DR. RICHARD C. APODACA, PC
Other - Org Name:EARLHAM FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:APODACA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-758-2323
Mailing Address - Street 1:110 S. CHESTNUT AVE PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:EARLHAM
Mailing Address - State:IA
Mailing Address - Zip Code:50072-0190
Mailing Address - Country:US
Mailing Address - Phone:515-758-2323
Mailing Address - Fax:515-758-3031
Practice Address - Street 1:110 S. CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:EARLHAM
Practice Address - State:IA
Practice Address - Zip Code:50072-0190
Practice Address - Country:US
Practice Address - Phone:515-758-2323
Practice Address - Fax:515-758-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1518937184OtherNPI INDIVIDUAL PROVIDER #