Provider Demographics
NPI:1629214077
Name:GANDER, RICHARD VICTOR (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:VICTOR
Last Name:GANDER
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 1:4200 WEST CONEJOS PLACE
Mailing Address - Street 2:SUITE LL5
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204
Mailing Address - Country:US
Mailing Address - Phone:720-956-0310
Mailing Address - Fax:720-956-0313
Practice Address - Street 1:4200 WEST CONEJOS PLACE
Practice Address - Street 2:SUITE LL5
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:720-956-0310
Practice Address - Fax:720-956-0313
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist