Provider Demographics
NPI:1518167568
Name:BUCK, RICHARD RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RYAN
Last Name:BUCK
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 1:9560 BASELINE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6435
Mailing Address - Country:US
Mailing Address - Phone:909-987-7676
Mailing Address - Fax:
Practice Address - Street 1:9560 BASELINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-6435
Practice Address - Country:US
Practice Address - Phone:909-987-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist