Provider Demographics
NPI:1598932568
Name:VERMILLION, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:VERMILLION
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 1:39 W LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1141
Mailing Address - Country:US
Mailing Address - Phone:570-645-2044
Mailing Address - Fax:571-645-9660
Practice Address - Street 1:39 W LUDLOW ST
Practice Address - Street 2:
Practice Address - City:SUMMIT HILL
Practice Address - State:PA
Practice Address - Zip Code:18250-1141
Practice Address - Country:US
Practice Address - Phone:570-645-2044
Practice Address - Fax:571-645-9660
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA312861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice