Provider Demographics
NPI:1003838038
Name:DANA, RICHARD M (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:DANA
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 1:10 MAGAZINE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-876-8734
Mailing Address - Fax:617-876-9518
Practice Address - Street 1:10 MAGAZINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-876-8734
Practice Address - Fax:617-876-9518
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice