Provider Demographics
NPI:1679545305
Name:RICHTER, HARRY MARK (DDS MAGD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:MARK
Last Name:RICHTER
Suffix:
Gender:M
Credentials:DDS MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG 5513
Mailing Address - Street 2:412TH MEDICAL GROUP - EDWARDS AIR FORCE BASE
Mailing Address - City:EDWARDS
Mailing Address - State:CA
Mailing Address - Zip Code:93524-0001
Mailing Address - Country:US
Mailing Address - Phone:661-277-2972
Mailing Address - Fax:
Practice Address - Street 1:BLDG 5513
Practice Address - Street 2:412TH MEDICAL GROUP - EDWARDS AIR FORCE BASE
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93524-0001
Practice Address - Country:US
Practice Address - Phone:661-277-2972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9303122300000X
PADS022268L122300000X
VA401005761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist