Provider Demographics
NPI:1508993130
Name:DESPRES, RICHARD L (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:DESPRES
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 1:2757 44TH ST SW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519
Mailing Address - Country:US
Mailing Address - Phone:616-534-8133
Mailing Address - Fax:616-534-4610
Practice Address - Street 1:2757 44TH ST SW
Practice Address - Street 2:SUITE 202
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-534-8133
Practice Address - Fax:616-534-4610
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010129851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice