Provider Demographics
NPI:1295758134
Name:DELLORK, RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:DELLORK
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 1:124 PARK ST SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4654
Mailing Address - Country:US
Mailing Address - Phone:703-281-5522
Mailing Address - Fax:703-281-2142
Practice Address - Street 1:124 PARK ST SE
Practice Address - Street 2:SUITE 205
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4654
Practice Address - Country:US
Practice Address - Phone:703-281-5522
Practice Address - Fax:703-281-2142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA64781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics