Provider Demographics
NPI:1205922598
Name:BIRCHLER, RICHARD A (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BIRCHLER
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 1:300 MAIN ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1343
Mailing Address - Country:US
Mailing Address - Phone:765-742-4500
Mailing Address - Fax:765-742-4500
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:SUITE 610
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1343
Practice Address - Country:US
Practice Address - Phone:765-742-4500
Practice Address - Fax:765-742-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN64731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice