Provider Demographics
NPI:1841224789
Name:CONDOS, RICHARD CARL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CARL
Last Name:CONDOS
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 1:864 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2516
Mailing Address - Country:US
Mailing Address - Phone:610-525-5171
Mailing Address - Fax:610-525-5190
Practice Address - Street 1:864 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2516
Practice Address - Country:US
Practice Address - Phone:610-525-5171
Practice Address - Fax:610-525-5190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017173L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice