Provider Demographics
NPI:1295273365
Name:PORTALUPI, RICHARD H (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:PORTALUPI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
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Mailing Address - Street 1:1204 COTTONWOOD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-4362
Mailing Address - Country:US
Mailing Address - Phone:530-662-9191
Mailing Address - Fax:530-662-3568
Practice Address - Street 1:1204 COTTONWOOD ST STE 1
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-4362
Practice Address - Country:US
Practice Address - Phone:530-662-9191
Practice Address - Fax:530-662-3568
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA250661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics