Provider Demographics
NPI:1689878670
Name:RICHMONDVILLE FAMILY DENTAL PRACTICE, PLLC.
Entity Type:Organization
Organization Name:RICHMONDVILLE FAMILY DENTAL PRACTICE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:CHICHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-294-6015
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:303 MAIN ST
Mailing Address - City:RICHMONDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12149-0492
Mailing Address - Country:US
Mailing Address - Phone:518-294-6015
Mailing Address - Fax:518-294-6017
Practice Address - Street 1:303 MAIN ST.
Practice Address - Street 2:
Practice Address - City:RICHMONDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12149-0492
Practice Address - Country:US
Practice Address - Phone:518-294-6015
Practice Address - Fax:518-294-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty