Provider Demographics
NPI:1619967791
Name:BEDINGHAUS, RICHARD M (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BEDINGHAUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 RED STEM DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-6189
Mailing Address - Country:US
Mailing Address - Phone:501-442-6316
Mailing Address - Fax:
Practice Address - Street 1:1200 KIRTS BLVD
Practice Address - Street 2:STE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4899
Practice Address - Country:US
Practice Address - Phone:248-528-1981
Practice Address - Fax:248-528-2963
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010208561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1619967791Medicaid