Provider Demographics
NPI:1558911784
Name:JOHN R RICHARD DDS PC
Entity Type:Organization
Organization Name:JOHN R RICHARD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-569-0131
Mailing Address - Street 1:5995 REEVES RD
Mailing Address - Street 2:
Mailing Address - City:E PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-1530
Mailing Address - Country:US
Mailing Address - Phone:717-569-0131
Mailing Address - Fax:
Practice Address - Street 1:5995 REEVES RD
Practice Address - Street 2:
Practice Address - City:E PETERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17520-1530
Practice Address - Country:US
Practice Address - Phone:717-569-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental