Provider Demographics
NPI:1508933524
Name:AUDET, RICHARD CLEMENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CLEMENT
Last Name:AUDET
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 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2105
Mailing Address - Country:US
Mailing Address - Phone:860-679-8071
Mailing Address - Fax:
Practice Address - Street 1:31 LIBERTY STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3114
Practice Address - Country:US
Practice Address - Phone:860-628-0385
Practice Address - Fax:860-621-9359
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0071381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice