Provider Demographics
NPI:1518420926
Name:UPTON, RICHARD WILLIAM HENSHAW (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WILLIAM HENSHAW
Last Name:UPTON
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 1:640 GLEN IRIS DR NE APT 516
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2762
Mailing Address - Country:US
Mailing Address - Phone:919-616-5522
Mailing Address - Fax:
Practice Address - Street 1:800 MOUNT VERNON HWY NE STE 405
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4293
Practice Address - Country:US
Practice Address - Phone:770-394-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty