Provider Demographics
NPI:1861638132
Name:RICHARD F STAFFORD DDS INC
Entity Type:Organization
Organization Name:RICHARD F STAFFORD DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-856-9502
Mailing Address - Street 1:321 N LARCHMONT BLVD STE 721
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6407
Mailing Address - Country:US
Mailing Address - Phone:323-856-9502
Mailing Address - Fax:
Practice Address - Street 1:321 N LARCHMONT BLVD STE 721
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6407
Practice Address - Country:US
Practice Address - Phone:323-856-9502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274911223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty