Provider Demographics
NPI:1821098807
Name:MOUNCE, RICHARD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:MOUNCE
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:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:NESKOWIN
Mailing Address - State:OR
Mailing Address - Zip Code:97149-0467
Mailing Address - Country:US
Mailing Address - Phone:605-786-4141
Mailing Address - Fax:
Practice Address - Street 1:244 E ELLENDALE AVE STE 4
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1523
Practice Address - Country:US
Practice Address - Phone:503-400-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1191501223E0200X
SDD09061223E0200X
ORD107781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics