Provider Demographics
NPI:1295935690
Name:TOWNSLEY, RICHARD WAYNE III (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WAYNE
Last Name:TOWNSLEY
Suffix:III
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 1:1320 SHALIMAR DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-3376
Mailing Address - Country:US
Mailing Address - Phone:817-235-6485
Mailing Address - Fax:
Practice Address - Street 1:3608 ALTAMESA BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-5641
Practice Address - Country:US
Practice Address - Phone:817-294-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184897001Medicaid