Provider Demographics
NPI:1508904046
Name:TATE, RICHARD HORNE (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HORNE
Last Name:TATE
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 1:701 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5167
Mailing Address - Country:US
Mailing Address - Phone:540-389-0491
Mailing Address - Fax:540-389-5136
Practice Address - Street 1:701 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5167
Practice Address - Country:US
Practice Address - Phone:540-389-0491
Practice Address - Fax:540-389-5136
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA57761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics