Provider Demographics
NPI:1528214491
Name:DERR, RICHARD SHELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SHELDON
Last Name:DERR
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 1:154 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-1204
Mailing Address - Country:US
Mailing Address - Phone:585-496-5411
Mailing Address - Fax:
Practice Address - Street 1:154 NORTH ST
Practice Address - Street 2:
Practice Address - City:ARCADE
Practice Address - State:NY
Practice Address - Zip Code:14009-1204
Practice Address - Country:US
Practice Address - Phone:585-496-5411
Practice Address - Fax:585-496-7492
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0358791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice