Provider Demographics
NPI:1679554414
Name:RICHARD J. STEIN DDS, PA
Entity Type:Organization
Organization Name:RICHARD J. STEIN DDS, PA
Other - Org Name:STEIN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-225-5682
Mailing Address - Street 1:208 W ROSS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2133
Mailing Address - Country:US
Mailing Address - Phone:620-225-5682
Mailing Address - Fax:620-225-5383
Practice Address - Street 1:208 W ROSS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2133
Practice Address - Country:US
Practice Address - Phone:620-225-5682
Practice Address - Fax:620-225-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0100222390BMedicaid