Provider Demographics
NPI:1396432688
Name:HERNANDEZ, RICHARD RICHAUD (DMD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:RICHAUD
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15324 S LAKE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5747
Mailing Address - Country:US
Mailing Address - Phone:209-247-8003
Mailing Address - Fax:
Practice Address - Street 1:15324 S LAKE BLUFF DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5747
Practice Address - Country:US
Practice Address - Phone:209-247-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13346638-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist