Provider Demographics
NPI:1629265004
Name:KILMER, RICHARD MARK (DDS MS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:MARK
Last Name:KILMER
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:1568 CREEKSIDE DR
Mailing Address - Street 2:STE 104
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-983-5321
Mailing Address - Fax:916-983-5326
Practice Address - Street 1:1568 CREEKSIDE DR
Practice Address - Street 2:STE 104
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-983-5321
Practice Address - Fax:916-983-5326
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
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Provider Licenses
StateLicense IDTaxonomies
CA0346221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics