Provider Demographics
NPI:1477760114
Name:ARDIS, RICHARD LESTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESTER
Last Name:ARDIS
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 1:2850 MESA VERDE DR
Mailing Address - Street 2:#F
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4857
Mailing Address - Country:US
Mailing Address - Phone:714-641-3272
Mailing Address - Fax:
Practice Address - Street 1:2850 MESA VERDE DR
Practice Address - Street 2:#F
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4857
Practice Address - Country:US
Practice Address - Phone:714-641-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist