Provider Demographics
NPI:1245466804
Name:CLABAUGH, RICHARD A III (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:CLABAUGH
Suffix:III
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1530 S 70TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1567
Mailing Address - Country:US
Mailing Address - Phone:402-483-1009
Mailing Address - Fax:
Practice Address - Street 1:1530 S 70TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1567
Practice Address - Country:US
Practice Address - Phone:402-483-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE71211223X0400X
SDD11001223X0400X
MO20140183831223X0400X
KS606901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics