Provider Demographics
NPI:1508024050
Name:OBERLY, RICHARD D (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:OBERLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5233
Mailing Address - Country:US
Mailing Address - Phone:607-272-2081
Mailing Address - Fax:607-272-8629
Practice Address - Street 1:523 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5233
Practice Address - Country:US
Practice Address - Phone:607-272-2081
Practice Address - Fax:607-272-8629
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043330-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist