Provider Demographics
NPI:1295796779
Name:GIDDON, RICHARD L (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GIDDON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4 METRO TECH CENTER
Mailing Address - Street 2:LOBBY
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-403-0700
Mailing Address - Fax:718-403-0441
Practice Address - Street 1:4 METRO TECH CENTER
Practice Address - Street 2:LOBBY
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-403-0700
Practice Address - Fax:718-403-0441
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0344661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00423890Medicaid