Provider Demographics
NPI:1518937184
Name:APODACA, RICHARD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:APODACA
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:EARLHAM
Mailing Address - State:IA
Mailing Address - Zip Code:50072-0190
Mailing Address - Country:US
Mailing Address - Phone:515-758-2323
Mailing Address - Fax:515-758-3031
Practice Address - Street 1:110 S CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:EARLHAM
Practice Address - State:IA
Practice Address - Zip Code:50072-2001
Practice Address - Country:US
Practice Address - Phone:515-758-2323
Practice Address - Fax:515-758-3031
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA70071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA165233OtherDELTA DENTAL
IA16523OtherWELLMARK BC/BS
IA734962OtherUNITED CONCORDIA