Provider Demographics
NPI:1205806502
Name:TOBIAS, RICHARD TARLETON (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TARLETON
Last Name:TOBIAS
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 1:2199 WOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-4131
Mailing Address - Country:US
Mailing Address - Phone:901-759-4079
Mailing Address - Fax:
Practice Address - Street 1:1724 NEBRASKA AVE
Practice Address - Street 2:BLDG 1608
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8939
Practice Address - Country:US
Practice Address - Phone:573-596-0364
Practice Address - Fax:573-596-0410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS29541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice