Provider Demographics
NPI:1578616231
Name:BLUME, RICHARD FRED (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRED
Last Name:BLUME
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:1001 BUCKINGHAM RD
Mailing Address - Street 2:SU. 102
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5850
Mailing Address - Country:US
Mailing Address - Phone:972-235-3131
Mailing Address - Fax:972-235-7754
Practice Address - Street 1:1001 BUCKINGHAM RD
Practice Address - Street 2:SU. 102
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5850
Practice Address - Country:US
Practice Address - Phone:972-235-3131
Practice Address - Fax:972-235-7754
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX85021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics