Provider Demographics
NPI:1487627618
Name:VERDERAME, RICHARD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:VERDERAME
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 BARBARA LOOP SE
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1068
Mailing Address - Country:US
Mailing Address - Phone:505-891-3000
Mailing Address - Fax:505-891-3001
Practice Address - Street 1:4111 BARBARA LOOP SE
Practice Address - Street 2:SUITE E-2
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1068
Practice Address - Country:US
Practice Address - Phone:505-891-3000
Practice Address - Fax:505-891-3001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD16121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics