Provider Demographics
NPI:1134409147
Name:SEDWICK, RICHARD W (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:SEDWICK
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 1:5500 MONUMENT AVE
Mailing Address - Street 2:#G
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1452
Mailing Address - Country:US
Mailing Address - Phone:804-282-4646
Mailing Address - Fax:
Practice Address - Street 1:5500 MONUMENT AVE
Practice Address - Street 2:#G
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1452
Practice Address - Country:US
Practice Address - Phone:804-282-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice