Provider Demographics
NPI:1508919036
Name:LINES, RICHARD R JR (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:LINES
Suffix:JR
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 1:1228 SPRUCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKTON
Mailing Address - State:PA
Mailing Address - Zip Code:15856-4012
Mailing Address - Country:US
Mailing Address - Phone:814-583-7879
Mailing Address - Fax:814-236-3402
Practice Address - Street 1:62 MAIN STREET BOX 254
Practice Address - Street 2:
Practice Address - City:GRAMPIAN
Practice Address - State:PA
Practice Address - Zip Code:16838
Practice Address - Country:US
Practice Address - Phone:814-236-3390
Practice Address - Fax:814-236-3402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025196L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice