Provider Demographics
NPI:1780677781
Name:PFAU, RICHARD JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:PFAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 COMMERCIAL ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-1016
Mailing Address - Country:US
Mailing Address - Phone:503-362-9151
Mailing Address - Fax:503-362-9184
Practice Address - Street 1:848 COMMERCIAL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1016
Practice Address - Country:US
Practice Address - Phone:503-362-9151
Practice Address - Fax:503-362-9184
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice