Provider Demographics
NPI:1861823536
Name:MAUTNER, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MAUTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3325
Mailing Address - Country:US
Mailing Address - Phone:305-531-0841
Mailing Address - Fax:305-531-2808
Practice Address - Street 1:925 ARTHUR GODFREY RD STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3338
Practice Address - Country:US
Practice Address - Phone:305-531-0841
Practice Address - Fax:305-531-2808
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL69091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics