Provider Demographics
NPI:1881633139
Name:STREETER, RICHARD LLOYD (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LLOYD
Last Name:STREETER
Suffix:
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 1:19 PENDLETON PL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2169
Mailing Address - Country:US
Mailing Address - Phone:423-288-6260
Mailing Address - Fax:
Practice Address - Street 1:1105 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-2558
Practice Address - Country:US
Practice Address - Phone:423-247-7731
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN49991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice