Provider Demographics
NPI:1659486397
Name:RICHARD H REAL. JR., D.M.D., P.A.
Entity Type:Organization
Organization Name:RICHARD H REAL. JR., D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:REAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-823-2577
Mailing Address - Street 1:2161 CLEARBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226
Mailing Address - Country:US
Mailing Address - Phone:205-823-2577
Mailing Address - Fax:205-823-2585
Practice Address - Street 1:2161 CLEARBROOK ROAD
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226
Practice Address - Country:US
Practice Address - Phone:205-823-2577
Practice Address - Fax:205-823-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2931CS122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty