Provider Demographics
NPI:1013976695
Name:POWELL, RICHARD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:POWELL
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 1:1456 KADERLY ST NW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-1243
Mailing Address - Country:US
Mailing Address - Phone:330-364-8665
Mailing Address - Fax:330-364-8667
Practice Address - Street 1:1456 KADERLY ST NW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-1243
Practice Address - Country:US
Practice Address - Phone:330-364-8665
Practice Address - Fax:330-364-8667
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH196561223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH43-00090OtherUNITED HEALTH CARE
OH0882077Medicaid
OH68035OtherUNITED CONCORDIA
OH43-00090OtherUNITED HEALTH CARE
OH0882077Medicaid