Provider Demographics
NPI:1457521163
Name:DR RICHARD K AKIN
Entity Type:Organization
Organization Name:DR RICHARD K AKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:AKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-467-4229
Mailing Address - Street 1:1013 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BAY SAINT LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1524
Mailing Address - Country:US
Mailing Address - Phone:228-467-4229
Mailing Address - Fax:228-467-4354
Practice Address - Street 1:1013 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BAY SAINT LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1524
Practice Address - Country:US
Practice Address - Phone:228-467-4229
Practice Address - Fax:228-467-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05981577Medicaid