Provider Demographics
NPI:1790789758
Name:RHODES, RICHARD BAXTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BAXTER
Last Name:RHODES
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 1:2 PLEASANT GROVE LANE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2547
Mailing Address - Country:US
Mailing Address - Phone:607-257-5588
Mailing Address - Fax:
Practice Address - Street 1:2 PLEASANT GROVE LANE
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2547
Practice Address - Country:US
Practice Address - Phone:607-257-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist