Provider Demographics
NPI:1710291596
Name:SMITH, RICHARD PARKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PARKER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W BASELINE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-5371
Mailing Address - Country:US
Mailing Address - Phone:480-612-5632
Mailing Address - Fax:
Practice Address - Street 1:825 W BASELINE RD STE 6
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-5371
Practice Address - Country:US
Practice Address - Phone:480-777-5570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038419122300000X
AZD009176122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist