Provider Demographics
NPI:1508976689
Name:METZ, RICHARD B (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:METZ
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 1:82 BALLARDS CORNER RD
Mailing Address - Street 2:PO BOX 387
Mailing Address - City:HINESBURG
Mailing Address - State:VT
Mailing Address - Zip Code:05461
Mailing Address - Country:US
Mailing Address - Phone:802-482-3155
Mailing Address - Fax:802-482-2113
Practice Address - Street 1:82 BALLARDS CORNER RD
Practice Address - Street 2:
Practice Address - City:HINESBURG
Practice Address - State:VT
Practice Address - Zip Code:05461
Practice Address - Country:US
Practice Address - Phone:802-482-3155
Practice Address - Fax:802-482-2113
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160000703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0006464Medicaid