Provider Demographics
NPI:1891833596
Name:RICHARD C AXEL, DDS, PA
Entity Type:Organization
Organization Name:RICHARD C AXEL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CARLYLE
Authorized Official - Last Name:AXEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-201-2425
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:NORWOOD YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55368-0429
Mailing Address - Country:US
Mailing Address - Phone:952-201-2425
Mailing Address - Fax:
Practice Address - Street 1:522 FAXON RD
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368
Practice Address - Country:US
Practice Address - Phone:952-201-2425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN76541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty