Provider Demographics
NPI:1841418639
Name:RICHARD R. NYMAN, D.D.S., P.A.
Entity Type:Organization
Organization Name:RICHARD R. NYMAN, D.D.S., P.A.
Other - Org Name:NORTH BRANCH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:NYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-674-7096
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0220
Mailing Address - Country:US
Mailing Address - Phone:651-674-7096
Mailing Address - Fax:651-674-7097
Practice Address - Street 1:6460 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-7030
Practice Address - Country:US
Practice Address - Phone:651-674-7096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty