Provider Demographics
NPI:1649273079
Name:MCGUCKIN, RICHARD S (DDS, MSC, MAGD, FACP)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:MCGUCKIN
Suffix:
Gender:M
Credentials:DDS, MSC, MAGD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4602
Mailing Address - Country:US
Mailing Address - Phone:207-866-2813
Mailing Address - Fax:207-866-3640
Practice Address - Street 1:160 PARK STREET
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-4602
Practice Address - Country:US
Practice Address - Phone:207-866-2813
Practice Address - Fax:207-866-3640
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-06-23
Provider Licenses
StateLicense IDTaxonomies
ME035131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics