Provider Demographics
NPI:1659443646
Name:RICHARD, CYRIL JAMES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYRIL
Middle Name:JAMES
Last Name:RICHARD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:C
Other - Middle Name:J
Other - Last Name:RICHARD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:30061 COLLEGE DR
Mailing Address - Street 2:PO BOX 459
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785
Mailing Address - Country:US
Mailing Address - Phone:225-664-0210
Mailing Address - Fax:225-664-0185
Practice Address - Street 1:30061 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785
Practice Address - Country:US
Practice Address - Phone:225-664-0210
Practice Address - Fax:225-664-0185
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice