Provider Demographics
NPI:1487823845
Name:RICHARD E. OFFUTT, DDS, PA
Entity Type:Organization
Organization Name:RICHARD E. OFFUTT, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:OFFUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-366-2744
Mailing Address - Street 1:6719 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-6355
Mailing Address - Country:US
Mailing Address - Phone:704-366-2774
Mailing Address - Fax:704-366-2639
Practice Address - Street 1:6719 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-6355
Practice Address - Country:US
Practice Address - Phone:704-366-2774
Practice Address - Fax:704-366-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty