Provider Demographics
NPI:1578646113
Name:KO, RICHARD D (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:KO
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 1:333 S INDIAN CANYON DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-416-0233
Mailing Address - Fax:760-416-0653
Practice Address - Street 1:333 S INDIAN CANYON DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-416-0233
Practice Address - Fax:760-416-0653
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice