Provider Demographics
NPI:1790089662
Name:HOMSEY, RICHARD SAM III (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAM
Last Name:HOMSEY
Suffix:III
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 1:1400 SE 4TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7328
Mailing Address - Country:US
Mailing Address - Phone:405-794-4497
Mailing Address - Fax:405-794-1922
Practice Address - Street 1:1400 SE 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-7328
Practice Address - Country:US
Practice Address - Phone:405-794-4497
Practice Address - Fax:405-794-1922
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist