Provider Demographics
NPI:1255318184
Name:SHANTY, RICHARD A (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:SHANTY
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 1:159 BUTLER RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2328
Mailing Address - Country:US
Mailing Address - Phone:724-543-5684
Mailing Address - Fax:724-543-3688
Practice Address - Street 1:159 BUTLER RD
Practice Address - Street 2:SUITE #4
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2328
Practice Address - Country:US
Practice Address - Phone:724-543-5684
Practice Address - Fax:724-543-3688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027979-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice