Provider Demographics
NPI:1023286499
Name:RICHEY, WAYNE LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:LEE
Last Name:RICHEY
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 1:880 CASS ST
Mailing Address - Street 2:#104
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 CASS ST
Practice Address - Street 2:#104
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2947
Practice Address - Country:US
Practice Address - Phone:831-373-3531
Practice Address - Fax:831-373-3571
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist