Provider Demographics
NPI:1851302749
Name:GANT, RICHARD BARKSDALE JR (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BARKSDALE
Last Name:GANT
Suffix:JR
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 1:655 SW BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5925
Mailing Address - Country:US
Mailing Address - Phone:910-692-6500
Mailing Address - Fax:910-692-6697
Practice Address - Street 1:655 SW BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5925
Practice Address - Country:US
Practice Address - Phone:910-692-6500
Practice Address - Fax:910-692-6697
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC93082OtherBCBS
NC8993082Medicaid
NC8993082Medicaid