Provider Demographics
NPI:1902027584
Name:RICHARD, LIONEL J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:J
Last Name:RICHARD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4432 CONLIN ST
Mailing Address - Street 2:2-A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2146
Mailing Address - Country:US
Mailing Address - Phone:504-885-6677
Mailing Address - Fax:504-885-6667
Practice Address - Street 1:4432 CONLIN ST
Practice Address - Street 2:2-A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2146
Practice Address - Country:US
Practice Address - Phone:504-885-6677
Practice Address - Fax:504-885-6667
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1841056Medicaid