Provider Demographics
NPI:1639135700
Name:RICHTER, ERIC J (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:RICHTER
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:PO BOX 555
Mailing Address - Street 2:49 WEST CHURCH STREET
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-0555
Mailing Address - Country:US
Mailing Address - Phone:802-472-5005
Mailing Address - Fax:
Practice Address - Street 1:49 WEST CHRUCH STREET
Practice Address - Street 2:
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843-0555
Practice Address - Country:US
Practice Address - Phone:802-472-5005
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT2335Medicaid