Provider Demographics
NPI:1467654178
Name:DENNIS, RICHARD L (DMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:DENNIS
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 1:28 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-2143
Mailing Address - Country:US
Mailing Address - Phone:518-935-0068
Mailing Address - Fax:518-306-5112
Practice Address - Street 1:28 CLINTON ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2143
Practice Address - Country:US
Practice Address - Phone:518-935-0068
Practice Address - Fax:518-301-5116
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice