Provider Demographics
NPI:1609259522
Name:KRATOCHVIL, RICHARD JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:KRATOCHVIL
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 1:7136 HASKELL AVE
Mailing Address - Street 2:#217
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4112
Mailing Address - Country:US
Mailing Address - Phone:818-787-6060
Mailing Address - Fax:
Practice Address - Street 1:7136 HASKELL AVE
Practice Address - Street 2:#217
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-787-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist